4 /eA» K.oia.Tvjortt, ,4
l
V1
***+++*.>*****^
FIRSTLINGS
i
PRACTICE of PHYSIC.
B Y
WILLIAM £ULLEN, M. D.
Profeflbr of the Practice of Phyffc in the Univcrfry r.f Edinburgh
Flrfc Phyilclan :o ln~ Majefly for Scotland ;
Fellow of the Royal College of Phyficians cf Edinburgh,
of the Royal Societies of London, of Edinburgh, &c. c<c.
A NEW EDITION,
Corrected and Enlarged.
IN FOUR VOLUMES.
VOL. IV.
: G H :
1 TOT, Edis burgh ;
E D I N B
Printed for C. ELL
And C. ELLIOT, T. KAY, & Co. at N°
Dr CuUen's Head^ Stvand, L o n dox.
M,DCCfLX\'\Vl!T.
.
-
tr
Cv3uvoVo<-a
i
J-> OCT O R
^ANDREW WIESENTH.
CONTENTS.
PART II. BOOK III.
Page
Sedt. III. Of the Spafniodic Affccliont in the
Natural Funclions - g
CHAP. VIII.
Of the Pyrosis, or -what is named in Scot-
land the Water-Brash - 9
CHAP. IX.
Of the Colic - - 18
CHAP. X.
Of the Cholera - 39
A 2 CHAP.
Medicw
iv C i\S.
Page
CHAP. XL
O/^Diarrhoea, or Looseness 49
CHAP. XII.
Of the Diabetes 82
CHAP. XIII.
Of the Hysteria, or the Hysteric
Disease - "93
CHAP. XIV.
Of Canine Madness and Hydro-
phobia - - 107
BOOK IV.
Of VESANIiE, or of the Disor-
ders of the Intellectual
Functions - - 111
CHAP.
CONTENTS.
CHAP. I.
Of Ve s a n i m in general
CHAP. II.
O/MANiAyor Madness
CHAP. III.
v
Page
III
I44
(^Melancholy, and other forms of
Infamty - - 168
PART III.
OF CACHEXIES
188
BOOK I.
Of EMACIATIONS - - 192
BOOK
vi .qO.NTENTS.
•
2
B O*
o JC
II.
•
-
Page
Of INTUMESCENTUE, or
General
Swellings
-
-
216
CHAP, I.
Of Adipose Swellings - 219
CHAP. II.
O/Tlatulent Swellings - 226
CHAP. III.
Of Watery Swellings, or Drop-
sies - - - 249
Se<5t. I. Of Ana/ana - - 277
Sedt. II. Of the Hydrothorax^or Dropfy
oftheBreq/i - - 308
Sea,
CONTENTS. vii
Tage
Sed. III. Of A/cites, or Dropfy of the
Lower Belly — - 321
CHAP. IV.
^General Swellings, arifingfrom
an increased bulk of the whole
fubflance ^Particular Parts 331
Of Rachitis , or Rickets - 332
BOOK III.
Of the 1MPETIGINES, or depra-
ved Habit, with Affections of
the Skin - - 357
CHAP. I.
Of Scrophula, or the King's Evil 359
CHAP.
viii CONTENTS,
Page
C H A P. II.
O^Sipyhlis, or the Venereal Dis-
ease - - 382
CHAP. III.
O/ScuRvy - - 412
CHAP. IV.
^/Jaundice . - 437
FIRST LINES
O F T H E
PRACTICE of PHYSIC.
PART II.
BOOK III. SECT. III.
Of the SPASMODIC AFFECTIONS
in the NATURAL FUNCTIONS.
C H A P.
VIII.
Of the Pyrosis, or what is named
in Scotland the Water-Brash.
MCCCCXXV1I.
PHE painful fenfations referred to the
•*• ftomach, and which are probably
occafioned by real affections of this organ,
Vol. IV. B are
io PRACTICE
are of different kinds. Probably they pro- .
ceed from affections of different natures,
and fliould therefore be diftinguifhed by dif-
ferent appellations ; but I muff own that
the ucmoft precifion in this matter will be
difficult. In my eflay towards a metho-
dical Nofology, 1 have, however, attempt-
ed it. For thofe pains that are either a-
cute and pungent, or accompanied with a
fenfe of diftention, or with a fenfe of con-
flri&ion, if they are at the fame time not
attended with any fenfe cf acrimony or
heat, 1 employ the appellation of Gaftro-
dynia. To exprefs thofe painful or unea-
fy fenfations which feem to arife from a
fenfe of acrimony irritating the part, or
from fuch a fenfe of heat as the applica-
tion of acrids, whether externally or in-
ternally applied, often gives, I employ the
term of Cardialgia ; and by this I particu-
larly mean to denote thofe feelings which
are exprefled by the term Heartburn in
the
O F P H Y S I C. u
the Englifh language. I think the term
Soda has been commonly employed by
practical writers to expreis an affection
attended with feelings of the latter kind.
MCCCCXXVIII.
Befide the pains denoted by the terms
Gaitrodynia, Periadynia, Cardialgia, and
Soda, there is, I think, another painful
fenfation different from all of thefe, which
is named by MrSauvages Pyrofis Suecica ;
and his account of it is taken from Lin-
naeus, who names it Cardialgia Sputatoria.
Under the title of Pyrofis Mr Sauvages has
formed a genus, of which the whole of the
fpecies, except the eighth, which he gives
under the title of Pyrofis Suecica, are all of
them fpecies of the Gaitrodynia or of the
Cardialgia ; and if there is a genus to be
formed under the title of Pyrofis, it can in
my opinion comprehend only the fpecies I
B 2 have
12 PRACTICE
have mentioned. In this cafe, indeed, I
own that the term is not very proper ; but
my averlion to introduce new names has
made me continue to employ the term of
Mr Sauvages.
MCCCCXXIX.
i
The Gaftrodynia and Cardialgia I judge
to be for the mod part fymptomatic af-
fe&ions ; and therefore have given them
no place in this work : but the Pyrofis, as
an idiopathic difeafe, and never before
treated of in any fyftem, I propofe to treat
of here.
MCCCCXXX.
It is a difeafe frequent among people in
lower life ; but occurs alfo, though more
rarely, in people of better condition.
Though frequent in Scotland, it is by no
means
O F P H Y S 1 C. 13
means Co frequent as Linnxus reports it
to be in Lapland. It appears moft: com-
monly in perfons under middle age, but
feldom in any perfons before the age of
puberty. When it has once taken place,
it is ready to recur occafionally for a long
time after ; but it feldom appears in per-
fons confiderably advanced in life It af-
fedls both fexes, but more frequently the
female. It fometimes attacks pregnant
women, and fome women only when they
are in that condition. Of other women,
it more frequently affects the unmarried ;
and of the married, mod frequently the
barren. I have had many inftances of its
occurring in women labouring under a
fluor albus.
MCCCCXXXI.
The fits of this difeafe ufually come on
in the morning and forenoon, when the
B 3 fto-
14 PRACTICE
ftomach is empty. The firft fympcom of
it is a pain at the pit of the ftomach, with
a fenfe of conftriction, as if the ftomach
was drawn towards the back ; the pain is
increafed by raifing the body into an erect
pofture, and therefore the body is bended
forward. This pain is often very fevere;
and, after continuing for fome time, it
brings on an erudiation of a thin watery
fluid in confiderable quantity. This fluid
has fometimes an acid tafte, but is very
often abfolutely infipid. The eructation is
for fome time frequently repeated ; and
does not immediately give relief to the
pain which preceded it, but does fo at
length, and puts an end to the fit.
MCCCCXXXII.
The fits of this difeafe commonly come
on, without any evident exciting caufe ;
ar.d I have not found it fteadily connec-
ted
OF PHYSIC, 15
ced with any particular diet. It attacks
perfons ufing animal food, but I think
more frequently thofe living on milk and
farinacea. It feems often to be excited by
cold applied to the lower extremities ; and
is readily excited by any considerable emo- *£** ^ y *^~*
tion of mind. It is often without any fymp- *— «,^«*~. v ~
toms of dyfpepfia. "
MCCCCXXXIII.
The nature of this affediion is not very
obvious ; but I think it may be explained
in this manner : It feems to begin by a
fpafm of the mufcular fibres of the fto-
mach ; which is afterwards, in a certain
manner, communicated to the blood- vef-
fels and exhalants, fo as to increafe the
impetus of the fluids in thefe veflels, while
a conftricftion takes place on their extre-
mities. While therefore the increafed im-
B 4 petus
16 PRACTICE
petus determines a greater quantity than
ufual of fluids into thefe vefTels, the con-
ftri&ion upon their extremities allows
only the pure watery parts to be poured
out, analogous, as I judge, in every re-
fpecfl, to what happens in the diabetes hy-
(lericus.
MCCCCXXX1V.
The pradlice in this difeafe is as diffi-*
cult as the theory. The paroxyfm is only
to be certainly relieved by opium. Other
antifpafmodics, as vitriolic ether and vo-
latile alkali, are fometimes of fervice, but
not conftaiitly fo. Although opium and
other antifpafmodics relieve the fits, they
hue no effed in preventing their recur-
rence. For this purpofe, the whole of
the remedies of dyfpepfia have been em-
ployed without fuccefs. Of the ufe of
the
O F P H Y S I C. 17
the mix vomica, mentioned as a reme-
dy by Linnaeus, I have had no expe-
rience.
CHAP.
PRACTICE 18
CHAP. IX.
Of The Colic,
MCCCCXXXV.
THE principal fymptom of this difeafe,
is a pain felc in the lower belly. It
is feldom fixed and pungent in one part,
but is a painful diftention in focne mea-
fure fpreading over the whole of the
belly; and particularly with a fenfe of
twifting or wringing round the navel. At
the fame time, with this pain, the navel
and
O F P H Y S I C. 19
and teguments of the belly are frequently
drawn inwards, and often the mufcles of
the belly are fpafmodically contracted, and
this in feparate portions, giving rhe ap-
pearance of a bag full of round balls.
mccccxxxvl
Such pains, in a certain degree, fome-
times occur in cafes of diarrhoea and cho-
lera ; but thefe are lefs violent and more
tranfitory, and are named Gripings. It is
only when more violent and permanent,
and attended with coftivenefs, that they
conftitute colic. This is alfo commonly
attended with vomiting, which in many
cafes is frequently repeated, efpecially when
any thing is taken down into the ftomach;
and in fuch vomitings, not only the con-
tents of the ftomach are thrown up, but
alfo the contents of the duodenum, and
therefore frequently a quantity of bile.
MCCCCXXXVII.
so PRACTICE
In fome cafes of colic, the periftaltic
motion is inverted through the whole
length of the alimentary canal, in fuch a
manner that the contents of the great guts,
and therefore ftercoraceous matter, is
thrown up by vomiting ; and the fame
inverfion appears (till more clearly from
this, that what is thrown into the re&um
by glyfter is again thrown out by the
mouth. In thefe circumftances of inver-
fion the difeafe has been named Ileus, or
the Iliac Paffion ; and this has been fup-
pofed to be a peculiar difeafe diftincft from
colic ; but to me it appears that the two
difeafes are owing to the fame proximate
caufe, and have the fame fymptoms, only
in different degree.
MCCCCXXXVIII.
O F P H Y S I C. it
MCCCCXXXVILI.
The colic is often without any pyrexia
attending it. Sometimes, however, an in-*
flammation comes upon the part of the
inteftine efpecially afFecled ; and this in-
flammation aggravates all the fymptoms of
the difeafe, being probably what brings on
the moft confiderable inverfion of the pe-
riftakic motion ; and, as the ftercoraceous
vomiting is what efpecially diftinguifhes
the ileus, this has been confidered as al-
ways depending on an inflammation of
the inteftines. However, I can affirm,
that as there are inflammations of the in-
teftines without ftercoraceous vomiting, fo
I have feen inftances of ftercoraceous vo-
miting without inflammation ; and there
is therefore no ground for diftinguifhing
ileus from colic, but as a higher degree of
the fame afFe&ion.
iMCCCCXXXIX.
22 PRACTICE
MCCCCXXXIX.
The fymptoms of the colic, and the dii-
fe&ions of bodies dead of this difeafe, (how
very clearly, that it depends upon a fpaf-
modic conftridlion of a part of the intef-
tines; and that this therefore is to be con-
fidered as the proximate caufe of the dif-
eafe. In fome of the difTe&ions of perfons
^/4^-WjAdead of this difeafe, an intus-fufception
jaj/ „at has been remarked to have happened ; but
4^ *H-
2l
" whether this be conflantly the cafe in all
a
the appearances of ileus, is not certainly de*
termined.
MCCCCXL.
The colic has commonly been coniider-
ed as being of different fpecies, but I can-
not follow the writers on this fubjedt in
the diftin&ions they have eftablifhed. So
far, however, Jfas a difference of the re-
i mote
O F P H Y S I C. 23
mote caufe conflitutes a difference of fpe-
cies, a diflin&ion may perhaps be admit-
ted ; and accordingly in my Nofology I
have marked feven different fpecies : but I
am well perfuaded, that in all thefe diffe-
rent fpecies the proximate caufe is the
fame, that is, a fpafmodic conftri&ion of a
part of the inteftines; and confequently,
that in all thefe cafes the indication of cure
is the fame, that is, to rempve the conftric-
tion mentioned. Even in the feveral fpe-
cies named Stercorea, Callofa, and CalculofaJ-*-"- **<^**.^
in which the difeafe depends upon anob-Z^^/2^-^
ftruaion of inteftine, 1 am perfuaded that^^^^L
thefe obftrudions do not produce thefymp- /£ , 4
toms of colic, excepting in fo far as theyy /- '* \-/^,
produce fpafmodic conftri&ions of the in- <*+ 3 -£>«*»*<*
teftines ; and therefore, that the means of
cure in thefe cafes, fo far as they admit of
cure, muft be obtained by the fame means
which the general indication above men-
tioned fuggefts.
MCCCGXLL
24 PRACTICE
MCCCCXLI.
The cure, then, of the colic univerfally,
is to be obtained by removing the fpafe
rnodic conftri6tions of the inteftines ; and
the remedies fuited to this purpofe may be
referred to three general heads :
i. The taking off the fpafm by various
antifpafmodic powers.
2. The exciting the a&ion of the intef-
tines by purgatives.
3. The employing mechanical dilata-
tion.
MCCCCXLII.
Before entering upon a more particular
account of thefe remedies, it will be pro-
per to obferve, that in all cafes of violent
colic, it is advifable to pra&ife blood-
letting; both as it may be ufeful in ob-
viating the inflammation which is com-*
1 monly
Of PHYSIC. 25
monly to be apprehended, and even as ir.
may be a means of relaxing the fpafm of
the intefline. This remedy may perhaps
be improper in perfons of a weak and lax
habit, but: in all perfons of tolerable vi-
gour it will be a fafe remedy; and in all
cafes where there is the lead fufpicion of
an inflammation actually coming on, it
will be abfolutely necelfary. Nay, it will
be even proper to repeat it perhaps feveral
times, if, with a full and hard pulfe, the
appearance of the blood drawn, and the
relief obtained by the firft bleeding, (hall
authorife fuch repetition.
MCCCCXLIII.
The antifpafmodic powers that may be
employed, are, the application of heat in a
dry or humid form, the application of
blifters, the ufe of opium, and the ufe of
mild oils.
Vol. IV. C The
26 PRACTICE
The application of heat, in a dry form*
has been employed by applying to the
belly of the patient a living animal, or
bladders filled with warm water, or bags
of fubftances which long retain their heat;
and all thefe have fometimes been applied
with fuccefs ; but none of them feem to
me fo powerful as the application of heat
in a humid form.
This may be employed either by the
immerfion of a great part of the body in
warm water, or by fomenting the belly
with cloths wrung out of hot water. The
immerfion has advantages from the appli-
cation of it to a greater part of the body,
and particularly to the lower extremities :
but immerfion cannot always be conve-
niently pradtifcd, and fomentation may
have the advantage of being longer conti-
nued j and it may have nearly all the be-
nefit of immerfion, if it be at the fame time
ap-
OF PHYSIC, 27
applied both to the belly and to the lower
extremities.
MCCCCXL1V.
From confidering that the teguments
of the lower belly have fuch a connection
with the inteftines, as at the fame time to
be affected with fpafmodic contractions,
we perceive that blifters applied to the
belly may have the effecft of taking off the
fpafms both from the mufcles of the belly
and from the inteftines ; and accordingly^
bliftering has often been employed in the
colic with advantage. Analogous to this,v^ m^o^^tju.
rubefacients^applied to the belly have been'^^-" tj^jj^.
frequently found ufefuh *0^*- 4+u #
<**.
MCCCCXLV.
The ufe of opium in colic may feein to
be an ambiguous remedy. Very certainly
C 2 it
28 PRACTICE
it may for fome time relieve the pain,
which is often fo violent and urgent, that
it is difficult to abflain from the ufeof fuch
a remedy. At the fame time, the ufe of
opium retards or fufpends the periftaltic
motion fo much, as to allow the inteftines
to fall into conftridlions ; and may there-
fore, while it relieves the pain, render the
caufe of the difeafe more obftinate. On
this account, and further as opium pre^
vents the operation of purgatives fo often
neceffary in this difeafe, many pra<5tition*
ers are averfe to the ufe of it, and fome en-
tirely reject the ufe of it as hurtful. There
are, however, others who think they can
employ opium in this difeafe with much
advantage.
In all cafes where the colic comes on
without any previous coftivenefr, and ari-
fes from cold, from paflions of the mind,
or other caufes which operate efpeciallyon
the nervous fyftem, opium proves a fafe
and
OF PHYSIC. 29
and certain remedy ; but in cafes which
have been preceded by long coftivenefs, or
where the colic, though not preceded by
coftivenefs, has however continued for
fome days without a (tool, to that a ftagna-
tion of faeces in the colon is to be fufpec-
ted, the ufe of opium is of doubftul effect.
In fuch cafes, unlefs a ftool has been firft
procured by medicine, opium cannot be
employed but with fome hazard of ag-
gravating the difeafe. However, even in
thofe circumftances of coftivenefs, when,
without inflammation, the violence of the
ipafm is to be fufpecled, when vomiting
prevents the exhibition of purgatives, and
when with all this the pain is extremely
urgent, opium is to be employed, not only
as an anodyne, but alfo as an antifpafmo-
dic, neceffary to favour the operation of
purgatives ; and may be fo employed,
when, either at the fame time with the o-
C 3 piate,
w PRACTICE
piate, or not long after it, a purgative can
be exhibited.
^ Is the hyofciamus^as often fhowing, a-
SfcJ^ . J <^*c Ion? with its narcotic, a purgative qua-
^•^ ^^Jity, better fuited to this difeafe than o-
--**~ - pium ?
MCCCCXLVI.
It is feemingly on good grounds that fe-
veral practitioners have recommended the
large ufe of mild oils in this difeafe, both
as antifpafmodics and as laxatives ; and,
where the palate and ftomach could admit
them, I have found them very ufeful. But
as there are few Scottifh ftomachs that can
admit a large ufe of oils, I have had few
opportunities of employing them.
MCCCCXLVIL
The fecond fet of remedies adapted to
the
O F P H Y S I C. 31
the cure of colic, are purgatives ; which,
by exciting the action of the inteftines, ci-
ther above or below the obftrucled place,
may remove the conftriction ; and there-
fore thefe purgatives may be given either
by the mouth, or thrown by glyfter into
the anus. As the difeafe is often feated in
the great guts; as glyflers, by having a
more fudden operation, may give more im-
mediate relief; and as purgatives given by
the mouth are ready to be rejected by vo-
miting ; fo it is common, and indeed pro-
per, to attempt curing the colic in the firft
place by glyflers. Thefe may at firft be
of the mildeft kind, confiding of a large
bulk of water, with fome quantity of a
mild oil; and fuch are fometimes fuffi*
ciently efficacious : however, they are not
always fo ; and it is commonly neceflary
to render them more powerfully ftimulant
by the addition of neutral falts, of which ^/.^j^
the mod powerful is the common or ma*
C 4 rine
32 PRACTICE
rine fait. If thefe faline glyflers, as fome-
times happens, are rendered again too
quickly, and on this account or otherwife
are found ineffectual, it may be proper, in-
ftead of thefe falts, to add to the glyfters
an infufion of fenna, or of fome other pur-
gative that can be extracted by water. The
antimonial wine may be fometimes em-
ployed in glyfters with advantage. Hardly
any glyfters are more effedlual than thofe
l*& made of turpentine properly prepared.*
\Zt^ f^ When all other injedlions are found inef-
yfedual, recourfe is to be had to the injec-
^A-i' tion of tobacco-fmoke : and, when evea
^2U-^ <*-£> this fails, recourfe is to be had to the me-
tsjji <r*±r*^ *"-
chanical dilatation to be mentioned here-
after.
MCCCCXLV1II.
As glyfters often fail altogether in relie-
ling this difeafe, and as even when they
give
OF P H Y S I C. 33
give fome relief they are often imperfedl
in producing a complete cure; fo it is ge-
nerally proper, and ofcen neceflary, to at*
tempt a more entire and certain cure by
purgatives given by the mouth. The more
powerful of thefe, or, as they are called,
the Draftic Purgatives, may be fometimes
neceflary ; but their ufe is to be avoided,
both becaufe they are apt to be rejected
by vomiting, and becaufe when they do
not fucceed in removing the obftru&ion
they are ready to induce an inflammation.
Upon this account it is ufual, and indeed
proper, at leaft in the firft place, to employ
the milder and lefs inflammatory purga-
tives. None have fucceeded with me
better than the cryftals of tartar, becaufe
this medicine may be conveniently given, J
in fmall but repeated dofes, to a confider-
able quantity ; and under this manage-
ment it is the purgative lead ready to be
rejected
34 PRACTICE
rejected by vomiting, and much lefs fo
than the other neutral falts. If a ftronger
purgative be required, jalap, properly pre-
&2 Jz^A-^y *6~— pared* is lefs offenfive to the palate, and
I i^^jLucS^^ better upon the ftomach, than raoft
^^f^'if^ other powerful purgatives. On many oc-
cafions of colic, nothing is more effectually
<f i^c purgative than a large dofe of calomel. ^
9^ Some practitioners have attempted to re-
move the obftrucflion of the inteftines by
antimonial emetics exhibited in fmall dofes
repeated at proper intervals ; and when
thefe dofes are not entirely rejected by
vomiting, they often prove effectual pur-
gatives.
When every purgative has failed, the
eft- J~^ acftion of the inteftines has been effectually
f^^ <■"*-■ excited by throwing cold water on the
lower extremities.
MCCCCXLIX
O F P H Y S I C. 3$
MCCCCXL1X.
The third means of overcoming the
fpafm of the inteftines in this difeafe, is
by employing a mechanical dilatation ;
and it has been frequently fuppofed that
quickfilver, given in large quantity, might
operate in this manner. 1 have not, how-
ever, found it fuccefsful ; and the theory
of it is with me very doubtful. Some au-
thors have mentioned the ufe of gold and
fllver pills, or balls, fwallowed down ; but
I have no experience of fuch practices, and
I cannot fuppofe them a probable means of
relief.
MCCCCL.
Another means of mechanical dilatation,
and a more probable meafure, is by injec-
ting a large quantity of warm water by a
proper fyringe, which may throw it with
fome
36 PRACTICE
fome force, and in a continued ftream, in-
to the redlum. Both from the experiments
<& 6*j». *~<J reported by the late Mr De Haen, and from
^JM thofe I myfelf have had occafion to make,
JL*~l X^*— / J judge this remedy to be one of the mod
t£lfj*2, j/powerful and effedtual.
fain*. &*J
*3* MCCCCLI.
~^Z- £.<*£ - '- •
••^T/io I have now mentioned all the feveral
^~ means that may be employed for the cure
of the colic, confidered as a genus ; but
before I quit this fubjecft, it may be ex-
pected that I fhould take notice of fome
of the fpecies which may feem to require
a particular confideration. In this view it
may be expedled that I fhould efpecially
take notice of that fpecies named the Colic
of Poitou, and particularly known in Eng-
land by the name of the Devonfhire Co-
lic.
MCCCCLIl
OF PHYSIC. 37
MCCCCLIT.
This fpccies of the difeafe is certainly a
peculiar one, both in refpeft of its caufc
and its efFe&s ; but, as to the firfl, it has
been lately fo much the fubjedt of invefti-
gation, and is fo well afcertained by the
learned phyficians Sir George Baker and
Dr Hardy, that it is unneceflary for me to
fay any thing of it here.
With refped to the cure of it, fo far as
it appears in the form of a colic, my want
of experience concerning it does not allow
me to fpeak with any confidence on the
fubjeft ; but, fo far as I can learn from
others, it appears to me, that it is to be
treated by all the feveral means that I have
propofed above for the cure of colic in ge-
neral.
How far the peculiar effe&s of this dif-
eafe are to be certainly forefeen and ob-
viated, I have not properly learned ; and I
muft
38 PRACTICE
muft leave the matter to be determined by
thofe who have had fufficient experience
in it.
CHAP.
OF PHYSIC. 39
CHAP. X
Of the Cholera
MCCCCLIII.
IN this difeafe, a vomiting and purging
concurring1 together, or frequently al-
ternating with one another, are the chief
fymptoms. The matter rejedled both up-
wards and downwards appears manifeftly
to confift chiefly of bile.
MCCCCLIV,
4o PRACTICE
MCCCCL1V.
From this laft circumftance I conclude,
that the difeafe depends upon an increafed
fecretion of bile, and its copious effuiion
into the alimentary canal ; and, as in this
it irritates and excites the motions above
mentioned, I infer, that the bile thus ef-
fufed in larger quantity is at the fame
time alfo of a more acrid quality. This
appears likewife from the violent and very
painful gripings that attend the difeafe,
and which we can impute only to the vio-
lent fpafmodic contractions of the intef-
tines that take place here. Thefe fpafms
are commonly communicated to the ab-
dominal mufcles, and very frequently to
thofe of the extremities.
MCCCCLV.
In the manner now deicribed, the dif-
i eafe
Of PHYSlC. 41
eafe frequently proceeds with great vio-
lence, till the ftrength of the patient is
greatly, and ofcen fuddenly, weakened ;
while a coldnefs of the extremities, cold
fweats, and faintings, coming on, an end
is put to the patient's life, fometimes in
the coiirfe of one day. In other cafes the
difeafe is lefs violent, continues for a day
or two, and then ceafes by degrees ; though
fuch recoveries feldom happen without the
afliftance of remedies*
MCCCCLVL
The attacks of this difeafe are feldom
accompanied with any fymptoms of py-
rexia ; and though, during the courfe
of it, both the pulfe and refpiration are
hurried and irregular, yet thefe fymp-
toms are generally fo entirely removed
by the remedies that quiet the fpaf-
modic affections peculiar to the difeafe,
Vol. IV, D a*
4* PRACTICE
as to leave no ground for fuppofing that it
Jiad been accompanied by any proper py-
rexia*
MCCCCLVII.
This is a difeafe attending a very warm
(late of the air ; and, in very warm cli-
mates, it may perhaps appear at any time
of the year : but even in fuch climates it
is mod frequent during their warmeft fea-
fons ; and in temperate climates, it ap-
pears only in the warm feafons. Dr Sy-
denham confidered the appearances of
this difeafe in England to be confined to
the month of Auguft ; but he himfelf ob-
ferved it to appear fometimes towards the
end of fummer, when the feafon was un-
ufually warm ; and that, in proportion to
the heat, the violence of the difeafe was
greater. Others have obferved that it
appeared more early in fummer, and al-
ways
O F P H Y S I C. 43
ways fooner or later, according as the great
heats fooner or later fet in.
MCCCCLVIII.
From all thefe circumftances, it is, I
think, very evident that this difeafe is
the effedl of a warm atmofphere, produ-
cing fome change in the (late of the bile
in the human body : and the change may
confift, either in the matter of the bile
being rendered more acrid, and thereby
fitted to excite a more copious fecretion ;
or, in the fame matter, its being prepa-
red to pafs off in larger quantity than
ufual.
MCCCCLIX,
It has been remarked, that in warm cli-
mates and feafons, after extremely hot and
dry weather, a fall of rain cooling the at-
D 2 mofpbere
44 PRACTICE
mofphere feems efpecially to bring on this
difeafe ; and it is very probable that an
obftrudted perfpiration may have alfo a
fhare in this, though it is alfo certain
that the difeafe does appear when no
change in the temperature of the air, nor
any application of cold, has been obfer-
ved.
MCCCCLX.
It is poflible, that, in fome cafes, the
heat of the feafon may give only a predif-
pofition, and that the difeafe may be ex-
cited by certain ingefta or other caufes ;
but it is equally certain, that the difeafe
has occurred without any previous change
or error, either in diet, or in the manner
of life, that could be obferved.
MCCCCLXL
OF PHYSIC. 45
MCCCCLXI.
The Nofologifts have conftituted a Ge-
nus under the title of Cholera, and under
this have arranged as fpecies every affec-
tion in which a vomiting and purging of
any kind happened to concur. In many
of thefe fpecies, however, the matter eva-
cuated is not bilious ; nor does the eva-
cuation proceed from any caufe in the
ftate of the atmofphere. Further, in many
of thefe fpecies alfo, the vomiting which
occurs is not an effential, but merely an
accidental, fymptom from the particular
violence of the difeafe. The appellation of
Cholera therefore fhould, in my opinion,
be confined to the difeafe I have defcribed
above ; which by its peculiar caufe, and
perhaps alfo by its fympcoms, is very dif-
ferent from all the other fpecies that have
been affociated with it. I believe that all
the other fpecies arranged under the title
D3 of
46 PRACTICE
of Cholera by Sauyages or Sagar, may be
properly enough referred to the genus of
Diarrhoea ; which we are to treat of in the
next chapter.
The diftin&ion I have endeavoured to
eftablifh between the proper Cholera, and
the other difeafes that have fometimes got
the fame appellation, will, as I judge, fu-
perfede the queftion, Whether the Chole-
ra, in temperate climates, happens at any
' other feafon than that above afligned i
MCCCCLXII.
In the cafe of a genuine cholera, the
cure of it has been long eftablifh^d by ex-
perience.
In the beginning of the difeafe, the eva-
cuation of the redundant bile is to be fa-
, voured by the plentiful exhibition of mild
^folL'tffa*" ^diluents, both given by the mouth, and
injefted by the anus \ and all evacuant
medi-
OF P H Y S I C. 47
medicines, employed in either way, are
not only fuperfluous, but commonly hurt-
ful.
MCCCCLX1H.
When the redundant bile appears to be
fufficiently wafhed out, and even before
that, if the fpafmodic affedlions of the ali-
mentary canal become very violent, and
are communicated in a confiderable de-
gree to other parts of the body, or when
a dangerous debility feems to be induced,
the irritation is to be immediately obvia-
ted by opiates, in fufficiently large dofes,
but in fmall bulk, and given either by the
mouth or by glyfter.
MCCCCLXIV.
Though the patient be in this manner
relieved, it frequently happens, that when
D 4 the
48 PRACTICE
the operation of the opium is over, the
difeafe fhows a tendency to return ; and,
for at leaft fome days after the firft attack,
the irritability of the inteftines, and their
difpofition to fall into painful fpafmodic
contractions, feem to continue. In this
fituation, the repetition of the opiates, for
perhaps feveral days, may come to be ne-
ceffary ; and as the debility commonly in-
duced by the difeafe favours the difpofition
to fpafmodic affecftions, it is often ufeful
and neceflary, together with the opiates,
to employ the tonic powers of the Peruvian
bark.
CHAP-
OF PHYSIC. 49
CHAP. XI.
Of Diarrhoea oh Looseness,
MCCCCLXV.
THIS difeafe confifts in evacuations by
(tool, more frequent and of more li-
quid matter than ufual. This leading and
charadlerift\c fymptom is fo diverfified in
its degree, in its caufes, and in the variety
of matter evacuated, that it is almoft im-
poffible to give any general hiftory of the
difeafe.
MCCCCLXVI.
5o PRACTICE
MCCCCLXVI.
It is to bediftinguifhed from dyfentery,
&^ „ **JzJ>l noc beIng contagious ; by being gene-
f,*^^-*£^X2\\y without fever ; and by being with
fl-J&~^~*~\}&t evacuation of the natural excrements,
C/~2fc~ - which are, at lead for fome time, retained
£j~fc*~j fo- |n dyfentery. The two difeafes have been
±- s~!y>*£A,^> commonly diftinguifhed by the gripings
a^Z, A being more violent in the dyfentery ; and
hf~ ^^^*they are commonly lefs violent and lefs
CtLjr-**^ frequent in diarrhoea; but as they fre-
;*~Uj«faJuj quently do occur in this alfo, and fome-
'^H£>^*^l- times to a confiderable degree, fo they do
not afford any proper diftin&ion.
MCCCCLXVII.
A diarrhoea is to be diftinguifhed from
cholera chiefly by the difference of their
caufes ; which, in cholera, is of one pecu-
liar kind ; but in diarrhoea is prodigioufly
diver-
O F P H Y S I C. s*
diverfified,as we fliall fee prefcntly. It has
been common to diftinguifh cholera by
the evacuation downwards being of bilious
matter, and by this being always accom-
panied with a vomiting of the fame kind;
but it does not univerfally apply, as a
diarrhoea is fometimes attended with vo-
miting, and even of bilious matter,
MCCCCLXVIII.
The difeafe of diarrhoea, thus diftin-
guifhed, is very greatly diversified ; but in
all cafes, the frequency of ftools is to be
imputed to a preternatural increafe of the
periftaltic motion in the whole, or at leafl
in a confiderable portion, of the inteftinai
canal. This increafed a&ion is in differ-
ent degrees, is often convulfive and fpaf-
modic, . and at any rate is a mot us abnor~
mis : for which reafon, in the Methodical
Nofology, I havejreferred it to the order
of
52 PRACTICE
of Spafmi, and accordingly treat of it in
this place.
MCCCCLX1X.
Upon the fame ground, as I confider
the difeafe named Lientery to be an in-
creafed periftaltic motion over the whole
of the inteftinal canal, arifing from a pe-
culiar irritability, I have confidered it as
merely a fpecies of diarrhoea. The idea of
a laxity of the inteftinal canal being the
caufe either of lientery, or other fpecies of
diarrhoea, appears to me to be without
foundation, except in the fingle cafe of
frequent liquid ftools from a palfy of the
[phinEier ani,
MCCCCLXX.
The increafed a&ion of the periftaltic
motion, I confider as always the chief part
of
O F P H Y S I C. 53
of the "proximate caufe of diarrhoea : but
the difeafe is farther, and indeed chiefly,
diverfified by the different caufes of this
increafed a&ion ; which we are now to
inquire into.
MCCCCLXXI.
The feveral caufes of the increafed ac-
tion of the inteftines may be referred, I
think, in the firft place, to two general
heads.
The Jirjl is, of the difeafes of certain
parts of the body which, either from a
confent of the inteftines with thefe parts,
or from the relation which the inteftines
have to the whole fyftem, occafion an in-
creafed acftion in the inteftines, without the
transference of any ftimulant matter from
the primary difeafed part to them.
The fecond head of the caufes of the in-
creafed aftion of the inteftines is of the
ftimuli
S4 PRACTICfe
ftimuli of various kinds, which are applied
dire&ly to the inteftines themfelves,
MCCCCLXXIL
That affe&ions of other parts of the fy
ftem may affeft the inteftines without the
transference or application of any ftimu-
lant matter, we learn from hence, that the
paflions of the mind do in fome perfons
excite diarrhoea*
MCCCCLXXIII.
That difeafes in other parts may in like
manner affedi the inteftines, appears from
the dentition of infants frequently ex-
citing diarrhoea. I believe that the gout
often affords another inftance of the fame
kind ; and probably there are others alfof
though not well afcertained.
i MCCCCLXXIV.
O F P H Y S I C. 55
MCCCCLXXIV.
The ftimuli (MCCCCLXXIV which
may be applied to the inteftines are of
very various kinds ; and are either,
i. Matters introduced by the mouth.
2. Matters poured into the inteftines by
the feveral excretories opening into them,
3. Matters poured from certain preter-
natural openings made into them in cer-
tain difeafes.
MCCCCLXXV.
Of thofe (MCCCCLXXlV.r) introdu-
ced by the mouth, the firft to be mention*
ed are the aliments commonly taken in.
Too great a quantity of thefe taken in,
often prevents their due digeflion in the
ftomach j and by being thus fent in their
crude, and probably acrid, ftate to the
in-
♦
I
56 PRACTICE
inteftines, they frequently excite diar-»
rhoea.
The fame aliments, though in proper
quantity, yet having too great a propor-*
tion, as frequently happens, of faline of
faccharine matter along with them, prove
ftimulant to the inteftines, and excite
diarrhoea.
But our aliments prove efpecially the
caufes of diarrhoea, according as they^
from their own nature, or from the weak-*
nefs of the ftomach, are difpofed to un-
dergo an undue degree of fermentation
there, and thereby become ftimulant to
the inteftines. Thus acefcent aliments are
ready to produce diarrhoea 5 but whether
from their having any diredly purgative
quality, or only as mixed in an over pro-
portion with the bile, is not well determi-
ned.
MCCCCLXXVI.
I ■
OF PHYSIC. 57
MCCCCLXXVL
Not only the acefcent, but alfo the pu-
trefcent difpofition of the aliments, feems
to occafion a diarrhoea; and it appears that
even the effluvia of putrid bodies, taken in
any way in large quantity, have the fame
effed.
Are oils or fats, taken in as a part of our
aliments, ever the caufe of diarrhoea ? and
if fo, in what manner do they operate ?
MCCCCLXXVIL
The other matters introduced by the
mouth, which may be caufes of diarrhoea,
are thofe thrown in either as medicines, or
poifons that have the faculty of ftimula-
ting the alimentary canal. Thus, in the
lift of the Materia Medica, we have a long
catalogue of thofe named purgatives ; and
in the lift of poifons, we have many pof-
Vol. IV. IL feffed
I
58 PRACTICE
fefled of the fame quality. The former,
given in a certain quantity, occafion a
temporary diarrhoea ; and given in very
large dofes, may occafion it in excefs, and
continue it longer than ufual, producing
that fpecies of diarrhoea named a Hyper-
catharfis.
MCCCCLXXVIII.
The matters (MCCCCLXXIV. 2 ) pour-
ed into the cavity of the inteftines from
the excretories opening into them, and
which may occafion diarrhoea, are either
thofe from the pancreatic or biliary du6l,
or thofe from the excretories in the coats
of the inteftines themfelves.
MCCCCLXXIX.
What changes may happen in the pan-
creatic juice, I do not exa&ly know ; but I
fuppofe
•^
OF PHYSIC. S9
fuppofe that an acrid fluid may ifTue from
the pancreas, even while (till entire in its
ftru'fiure ; but more efpecially when in is
in a fuppurated, fcirrhous, or cancerous
ftate, that a very acrid matter may be
poured out by the pancreatic du<£t, and oc-1
cafion diarrhoea.
MCCCCLXXX.
We know well, that from the biliary
dudl the bile may be poured out in greater
quantity than ufual ; and there is little
doubt of its being alfo fometimes poured
out of a more than ordinary acrid quality.
It is very probable, that in both ways the
bile is frequently a caufe of diarrhoea.
Though I have faid above that diarrhoea
may be commonly diilinguifhed from cho-
lera, I muft admit here, that as the caufes
producing that (late of the bile which oc-
cafions cholera, may occur in all the dif-
E 2 ferent
6o PRACTICE
ferent poflible degrees of force, fo as, on
one occafion, to produce the mod violent
and diftin&ly marked cholera; but, upon
another, to produce only the gentled diar-
rhoea ; which, however, will be the fame
difeafe, only varying in degree : So I
think it probable, that in warm climates,
and in warm feafons, a dlarrhcea biliofa of
this kind may frequently occur, not to be
always certainly diftinguifhed from cho-
lera.
However this may be, it is fufficiently
probable, that, in fome cafes, the bile, with-
out having been acted upon by the heat of
the climate or feafon, may be redundant
and acrid, and prove therefore a particular
caufe of diarrhoea.
MCCCCLXXXI.
Befide bile from the feveral caufes and
in the conditions mentioned, the biliary
duft
OF PHYSIC. 61
dud may pour out pus, or other matter,
from abfcefles in the liver, which may be
the caufe of diarrhoea.
Pra&ical writers take notice of a diar-
rhoea wherein a thin and bloody liquid is
difcharged ; which they fuppofe to have
proceeded from the liver, and have there-
fore given the difeafe the name of Hepa-
tirrhoea : but we have not met with any
inftance of this kind; and therefore cannot
properly fay any thing concerning it*
MCCCCLXXX1I.
A fecond fet of excretories, from which
matter is poured into the cavity of the in-
teftines, are thofe from the coats of the in-
teftines themfelves ; and are either the ex-
halants proceeding diredtly from the extre-
mities of arteries, or the excretories from
the mucous follicles: and both thefe four-
ces occur in prodigious number over the
E3 in-
62 PRACTICE
internal furface of the whole inteftinal
canal. It is probable that it is chiefly the
effufion from thefe fources which, in mod
inftances, gives the matter of the liquid
{tools occurring in diarrhoea.
MCCCCLXXXIII.
The matter from both fources may be
poured out in larger quantity than ufual,
merely by the increafed a&ion of the in-
teftines, whether that be excited by the
paflions of the mind (MCCCCXXIL),
by difeafes in other parts of the fyfteni
(MCCCCLXXI. t.), or by the various fti-
mulants mentioned MCCCCLXXV. and
following; or the quantity of matter pour-
ed out may be increafed, not fo much by
the increafed action of the inteftines, as by
an increafed afflux of fluids from other
parts of the fyftem.
Thus, cold applied to the furface of the
body,
OF PHYSIC.
63
body, and fuppreffing pevfpiration, may
determine a greater quantity of fluids to
the inteftines.
Thus, in the ifchuria renalls^ the urine ta-
ken into the blood- veflels is fometimes de-
termined to pafs off again by the inteftines.
la like manner, pus or ferum may be
abforbed from the cavities in which they
have been ftagnant, and be again poured
out into the inteftines, as frequently hap-
pens, in particular with refpedl to the wa-
ter of dropfies.
MCCCCLXXXIV.
It is to be obferved here, that a diar-
rhoea may be excited not only by a copious
afflux of fluids from other parts of the fy-
(lem, but likewife by the mere determi-
nation of various acrid matters from the
mafs of blood into the cavity of the inte-
ftines. Thus it is fuppofed that the mor-
E 4 bific
64 PRACTICE
bifk matter of fevers is fometimes thrown
out into the cavity of the inteftines, and
gives a critical diarrhoea : and whether I
do or do not admit the dodtrine of critical
evacuations, I think it is probable that the
morbific matter of the exanthemata is fre-
quently thrown upon the inteftines, and
occafions diarrhoea.
MCCCCLXXXV.
It is to me further probable, that the
putrefcent matter difFufed over the mafs
of blood in putrid difeafes, is frequently
poured out by the exhalants into the inte-
ftines, and proves there the caufe, at lead
in part, of the diarrhoea fo commonly at-
tending thefe difeafes.
MCCCCLXXXVL
Upon this fubjeft of the matters pout-
ed
OF PHYSIC. 65
ed into the cavity of the interlines, I have
chiefly confidered them as poured out in
unufual quantity : but it is probable that,
for the mod part, they are alfo changed
in their quality, and become of a more
acrid and ftimulant nature ; upon which
account efpecially it is, that they excite, or
at ieaft increafe, a diarrhoea.
MCCCCLXXXVII.
How far, and in what manner, the ex*
halant fluid may be changed in its nature
and quality, we do not certainly know :
but with refpedl to the fluid from the mu-
cous excretories, we know, that, when
poured out in unufual quantity, it is com-
monly, at the fame time, in a more liquid
and acrid form ; and may prove, therefore,
confiderably irritating.
MCCCCLXXXVIII.
66 PRACTICE
MCCCCLXXXV1II.
Though the copious effufion of a more
liquid and acrid matter from the mucous
excretories, be probably owing to the mat-
ter being poured out immediately as it is
fecreted from the blood into the mucous
follicles, without being allowed to ftagnate
in the latter, fo as to acquire that milder
quality and thicker confidence we com-
monly find in the mucus in its natural
{late ; and although we might fuppofe chat
the excretions of a thin and acrid fluid
fhould always be the effe£t of every deter-
mination to the mucous follicles, and of
every ftimulant applied to them : yet it is
certain, that the reverfe is fometimes the
cafe; and that, from the mucous follicles,
there is frequently an increafed excretion
of a mucus, which appears in its proper
form of a mild, vifcid, and thickifti matter.
This commonly occurs in the cafe of dy-
i fentery ;
or PHYSIC, 67
fentcry ; and it has been obferved to give
a fpecies of diarrhoea, which has been pro-
perly named the Diarrhea Mucofa.
MCCCCLXXXIX.
A third fource of matter poured into the
cavity of the inteftines, and occafioning
diarrhoea (MCCCCLXX1V. 3.), is from
thofe preternatural openings produced by
difeafes in the inteftines or neighbouring
parts. Thus the blood- veflels on the in-
ternal furface of the inteftines may be o-
pened by erofion, rupture, or anaftomo-
fis, and pour into the cavity their blood,
which, either by its quantity or by its a-
crimony, whether inherent, or acquired by
ftagnation, may fometimes give a diarrhoea
evacuating bloody matter. This is what
I think happens in that difeafe which has
been called the Melana or Morbus Niger*
MCCCCXC.
68 PRACTICE
MCCCCXC.
Another preternatural fource of matter
poured into the cavity of the inteftines, is
the rupture of abfceffes feated either in the
coats of the inteftines themfelves, or in any
of the contiguous vifcera, which, during
an inflamed ftate, had formed an adhefion
with fome part of the inteftines. The mat*-
ter thus poured into their cavity may be
various ; purulent, or famous, or both to^-
gether, mixed at the fame time with more
or lefs of blood; and in each of thefe Hates
may be a caufe of diarrhoea.
MCCCCXCI.
Amongft the ftimuli that may be di-
rectly applied to the inteftines, and which,
by increafing their periftaltic motion, may
occafion diarrhoea, I muft not omit to
men-
OF PHYSIC. 69
mention worms, as having frequently that
effetf.
MCCCCXC1I.
I muft alfo mention here a ftate of the
inteftines, wherein their periftaltic motion
is preternaturally increafed, and a diar-
rhoea produced ; and that is, when they
are affe&ed with an erythematic inflam-
mation, With refpedt to the exiftence of
fuch a ftate, and its occafioning diarrhoea,
fee what is faid above in CCCXCV11I.
and following. Whether it is to be con-
fidered as a particular and diftindt cafe of
diarrhoea, or is always the fame with fome
of thofe produced by one or other of the
caufes above mentioned, I have not been
able to determine.
MGCCCXCIIL
7o PRACTICE
MCCCCXCIII.
Laftly, by an accumulation of alimen-
tary or of other matter poured into the ca-
vity of the inteftines from feveral of the
fources above-mentioned, a diarrhoea may
be efpecially occafioned when the abforp-
tion of the la&eals, or of other abforbents,
is prevented, either by an obftrudUon of
their orifices, or by an obftru&ion of the
mefenteric glands, through which alone
the abforbed fluids can be tranfmitted.
In one inftance of this kind, when the
chyle prepared in the ftomach and duode-
num is not abforbed in the courfe of the
inteftines, but pafles off in confiderable
quantity by the anus, the difeafe has been
named Morbus Caliacus, or limply and more
properly Codiaca; which accordingly 1 have
confidered as a fpecies of diarrhoea.
MCCCCXCIV.
O F P H Y S I C. 7*
MCCCCXC1V.
I have thus endeavoured to point out
the various fpecies of difeafe that may
come under the general appellation of
Diarrhoea ; and from that enumeration it
will appear, that many, and indeed the
greater part of the cafes of diarrhoea, are
to be confidered as fympathetic affedions,
and to be cured only by curing the pri-
mary difeafe upon which they depend ; of
which, however, I cannot properly treat
here. From our enumeration it will alfo
appear, that many of the cafes of diarrhoea
which may be confidered as idiopathic,
will not require my faying much of them
here. In many inftances, the difeafe is af-
certained, and alfo the caufe affigned, by
the condition of the matter evacuated ; fo
that what is neceflfary to corredl or remove
it will be fufficiently obvious to practition-
ers of any knowledge. In fhort, I do not
find
72 PRACTICE
find that I can offer any general plan for
the cure of diarrhoea ; and all that I can
propofe to do on this fubjetft, is to give
fome general remarks on the practice that
has been commonly followed in the cure'
of this difeafe.
MCCCCXCV.
The pra&ice in this difeafe has chiefly
proceeded upon the fuppofition of an acri-
mony in the fluids, or of a laxity in the
Ample and moving fibres of the intensities-
and the remedies employed have accord-
ingly been, Correctors of particular acri-
mony, general demulcents, evacuants by
vomiting or purging, aftringents, or opi-
ates. Upon each of thefe kinds of remedy
I fhall now offer fome remarks.
MCCCCXCVI.
O F P H Y S I C. ?3
Mccccxcvr.
An acid acrimony is, upon feveral occa-
fions, the caufc of diarrhoea, particularly
in children ; and in fuch cafes the abfor-
bent earths have been very properly em-
ployed. The common, however, and pro-
mifcuous ufe of thefe, has been very inju-
dicious ; and where there is any putref-
cency, they mud be hurtful.
MCCCCXCVII.
The: cafes in which there is a putrid or
putrefcent acrimony prevailing, have been,
I think, too feldom taken notice of ; and,
therefore, the ufe of acids too feldom ad-
mitted. The acrimony to be fufpected in
bilious cafes, is probably of the putrefcent
kind.
Vol. IV. F MCCCCXCVIII,
74 PRACTICE
MCCCCXCVIII.
The general correctors of acrimony are
the mild diluents and demulcents. The
former have not been fo much employed
in diarrhoea as they ought ; for, joined
with demulcents, they very much increafc
the efFedls of the latter : and although the
demulcents, both mucilaginous and oily,
may by themfelves be ufeful, yet without
the afliftance of diluents they can hardly
be introduced in fuch quantity as to an*
fwer the purpofe.
MCCCCXCIX.
As indigeftion and crudities prefent in
the ftomach, are fo often the caufe of diar-
rhoea, vomiting mud therefore be fre-
quently very ufeful in this difeafe.
In like manner, when the difeafe pro-
ceeds, as it often does, from obftrudled per-
fpiration,
Of PHYSIC. 75
fpiration, and increafed afflux of fluids to
the inteftines, vomiting is perhaps the moft
effedual means of reftoring the determi-
nation of the fluids to the furface of the
body.
It is poflible alio, that vomiting may
give fome inverfion of the periftaltic mo-
tion, which is determined too much down-
wards in diarrhoea ; fo that upon the whole
it is a remedy which may be very gene-
rally ufeful in this difeafe.
Mb:
Purging has been fuppofed to be mofe
univerfally neceflary^ and has been more
generally pradlifed. This, however, in my
opinion, proceeds upon very miftaken no-
tions with refpedt to the difeafe; and fuch a
practice feems to me for the moft part fuper-
fluous, and in many cafes very hurtful. It
goes upon the fuppofition of an acrimony
F 2 pre-*
76 PRACTICE
prefent in the inteftines, that ought to be
carried out by purging : but, if that acri-
mony has either been introduced by the
mouth, or brought into the inteftines from
other parts of the body, purging can neither
be a means of correcting nor of exhauft-
ing it ; and muft rather have the effedt of
increafing its afflux, and of aggravating its
effecfls. From whatever fource the acri-
mony which can excite a diarrhoea pro-
ceeds, it may be fuppofed fufficient to eva-
cuate itfelf, fo far as that can be done by
purging ; and as in cholera, fo in the fame
kind of diarrhoea, it will be more proper
to affift the evacuation by diluents and de-
mulcents, than to increafe the irritation
by purgatives.
MDI.
If, then, the ufe of purgatives in diar-
rhoea may be confidered, even when
an acrimony is prefent, as fuperfluous,
there
i
O F P H Y S I C. 77
there are many other cafes in which it
may be extremely hurtful. If the irrita-
bility of the inteftines (hall, from affec-
tions in other parts of the fyftem, or other
caufes, have been already very much in-
creafed, purgatives mud neceflarily aggra-
vate the difeafe. In the cafe of lientery,
nobody thinks of giving a purgative ; and
in many cafes of diarrhoea approaching to
that, they mud be equally improper. I
have already obferved, that when diar-
rhoea proceeds from an afflux of fluids to
the inteftines, whether in too great quan-
tity, or of an acrid quality, purgatives
may be hurtful ; and whoever, therefore,
conflders the numerous and various four-
ces from which acrid matter may be
poured into the cavity of the inteftines,
will readily perceive, that, in many cafes
of diarrhoea, purgatives may be extremely
pernicious.
There is one cafe in particular to be ta-
F 3 ken
78 PRACTICE
ken notice of. When, from a general and
acrid difTolution of the blood, the ferous
fluids run off too copioufly into the cavity
of the inteftines, and excite that diarrhoea
which attends the advanced ftate of hedlic
fever, and is properly called a Colliqua-
tive Diarrhoea ; I have, in fuch cafes, often
feen purgatives given with the mod bane-
ful effe&s.
There is ftill another cafe of diarrhoea
in which purgatives are pernicious ; and
that is, when the difeafe depends, as we
have alleged it fometimes may, upon an
erythemathic inflammation of the inte-
flines.
I need hardly add, that if there be a
cafe of diarrhoea depending upon a laxity
of the folids, purgatives cannot there be
of any fervice, and may do much harm.
Upon the whole, it will, I think, appear,
that the ufe of purgatives in diarrhoea
is very much limited ; and that the pro-
mi f-
O F P H Y S I C. 79
jnifcuous ufe of them, which has been fo
common, is injudicious, and often perni-
cious. I believe the pra&ice has been
chiefly owing to the ufe of purgatives in
dyfenteric cafes, in which they are truly
ufeful ; becaufe, contrary to the cafe of
diarrhoea, there is in dyfentery a confide*
rable conftri&ion of the inteftines.
MDII.
Another fet of remedies employed in
diarrhoea are aftringents. There has been
fome hefitation about the employment of
thefe in recent cafes, upon the fuppofition
that they might occafion the retention of
an acrid matter that fhould be thrown out.
I cannot, however, well underftand or af-
fign the cafes in which fuch caution is
neceflary ; and I think that the power of
aftringents is feldom fo great as to render
their ufe very dangerous. The only difH-
F 4 culty
83 PRACTICE
culty which has occurred to me, with re-
fpedt to their ufe, has been to judge of the
circumftances to which they are efpecially
adapted. It appears to me to be only in
thofe where the irritability of the inte-
{lines depends upon a lofs of tone : and
this, I think, may occur either from the
debility of the whole fyftem, or from cau-
fes a&ing on the inteftines alone. All
violent or long-continued fpafmodic and
convulfive affections of the inteftinal canal
necefTarily induce a debility there; and
fuch caufes often take place, from violent
irritation, in colic, dyfentery, cholera, and
diarrhoea.
MDIIL
The lalt of the remedies of diarrhoea
that remain to be mentioned are opiates.
The fame obje&ions have been made to
the ufe of thefe, in recent cafes of diar-
rhoea,
D I iJ II Y S I C. ft
rhoea, as to that of aftringents; but on no
good grounds: for the effed of opiates, as
aftringent, is never very permanent ; and
an evacuation depending upon irritation,
though it may be for fome time fufpended
by opiates, yet always returns very foon.
It is only by taking off irritability that o-
piates are ufeful in diarrhoea ; and there-
fore, when the difeafe depends upon an
increafe of irritability alone, or when,tho'
proceeding from irritation, that irritation
is corre&ed or exhaufted, opiates are the
mod ufeful and certain remedy. And tho'
opiates are not fuited to corredl or remove
an irritation applied, they are often of great
benefit in fufpending the effects of that ir-
ritation whenever thefe are violent: andf
upon the whole, it will appear, that opiates
may be very frequently, and with great
propriety, employed in the cure of diar-
rhoea.
CHAP,
8a PRACTICE
CHAP. Xll
Op The Diabetes,
MDIV,
THIS difeafe confifts in the voiding
of an unufually large quantity of
urine.
As hardly any fecretion can be increafed
without an increafed adion of the veflels
"concerned in it, and as fome inftances of
this difeafe are attended with affections
manifeftly fpafmodic, I have had no doubt
of arranging the diabetes under the order
ofSpafmi.
' J&&J+- ^<S^~J~ir ■ MDV-
— tu~ 2~. **>-/* * - **> 'rt *:
PRACTICE 8j
MDV.
This difeafe is always accompanied with
a great degree of thirft, and therefore with
the taking in of a great quantity of drink.
This in fome meafure accounts for the
very extraordinary quantities of urine
voided : but dill, independent of this, a
peculiar difeafe certainly takes place; as
the quantity of urine voided does almoft
always exceed the whole of the liquids,
and fometimes the whole of both folids
and liquids, taken in.
MDVL
The urine voided in this difeafe is al-
ways very clear, and at firft fight appears
entirely without any colour ; but, viewed
in a certain light, it generally appears to
be flightly tinged with a yellowifh green,
and in this refpedl has been very properly
conv?
84 PRACTICE
compared to a folution of honey in a large
proportion of water.
Examined by the tafte, it is very gene-
rally found to be more or lefs fweet; and
many experiments that have now been
made in different inftances of the difeafe,
fhow clearly that fuch urine contains, in
confiderable quantity, a faccharine matter
which appears to be very exa&ly of the
nature of common fugar.
MDVII.
Dodor Willis feems to me to have been
the firft who took notice of the fweetnefs
of the urine in diabetes, and almoft every
phyfician of England has fince taken notice
of the fame. It is to be doubted, indeed,
if there is any cafe of idiopathic diabetes
in which the urine is of a different kind.
Though neither the ancients, nor, in the
other countries of Europe, the moderns,
till
OF PHYSia 85
till the latter were directed to it by the
Englifti, have taken notice of the fweetnefs
of the urine, it does not perfuade me, that
either in ancient or in modern times the
urine in diabetes was of another kind. I
myfelf, indeed, think I have met with one
inftance of diabetes in which the urine was
perfectly infipid ; and it would feem that
a like obfervation had occurred to Dr Mar-
tin Lifter. I am perfuaded, however, that
fuch inftances are very rare ; and that the
other is by much the more common, and
perhaps the almoft univerfal occurrence. I
judge, therefore, that the prefence of fuch
a faccharine matter may be confidered as
the principal circumftance in idiopathic
diabetes; and it gives at leaft the only cafe
of that difeafe that I can properly treat of
here, for I am only certain that what 1 am
further to mention relates to fuch a cafe.
MDVIIL
86
PRACTICE
MDVIII.
The antecedents of this difeafe, and con-4
fequently the remote caufes of it, have not
been well afcertained. It may be true that
it frequently happens to men who, for a
long time before, had been intemperate in
drinking ; that it happens to perfons of a
broken conftitution, or who, as we often
exprefs it, are in a cachedlic date \ that it
fometimes follows intermittent fevers ; and
that it has often occurred from excefs in
the drinking of mineral waters. But none
of thefe caufes apply very generally to the
cafes that occur : fuch cafes are not always,
nor even frequently, followed by a dia-
betes ; and there are many inftances of
diabetes which could not be referred to
any of them. In moft of the cafes of this
difeafe which I have met with, I could not
refer it to any particular caufe.
i MDIX
OF PHYSIC. 87
MDIX.
This difeafe commonly comes on flow-
ly, and almoft imperceptibly, without any
previous diforder. It often arifes to a con-
fiderable degree, and fubfifts long without
being accompanied with evident diforder
in any particular part of the fyftem. The
great thirft which always, and the vora-
cious appetite which frequently, occurs in
it, are often the only remarkable fymp-
toms. Under the continuance of the dif-
eafe, the body is often greatly emaciated ;
and a great weaknefs alfo prevails. The
pulfeis commonly frequent; and an obfcure
fever is for the mod part prefent. "When
the difeafe proves fatal, it generally ends
with a fever, in many circumftances, par-
ticularly thofe of emaciation and debility,
refembling a he&ic.
MDX.
88 PRACTICE
MDX.
The proximate caufe of this difeafe is
not certainly or clearly known. It feems
to have been fometimes conne&ed with
calculous affe&ions of the kidneys j and it
is poflible, that an irritation applied there
may increafe the fecretion of urine. It
perhaps often does fo ; but how it fhould
produce the Angular change that takes
place in the ftate of the urine, is not to be
eafily explained. It certainly often happens,
that calculous matters are long prefent in
the urinary paflages, without having any
fuch effedt as that of producing diabetes in
any fhape.
Some have fuppofed that the difeafe oc-
curs from a relaxed ftate of the fecretory
vefTels of the kidneys; and indeed the dif-
fecflions of perfons who had died of this
difeafe have (hown the kidneys in a very
flaccid ftate. This, however, is probably
i to
OF PHYSIC. 89
to be conlidered as rather the effect than
the Caufe of the difeafe.
That no topical aiTecftion of the kidneys
has a ihare in producing this difeafe, and
that a fault in the aflimilation of the fluids
is rather to be blamed, I conclude from
hence, that even the folid food taken in,
increafes the quantity of the urine voided,
at the fame time with an increafe of the
faccharine matter above-mentioned.
MDXI.
The diabetes has been fuppofed to be
owing to a certain ftate of the bile; and it
is true, that this difeafe has fometimes oc-
curred in perfons who were at the fame
time affe&ed with difeafes of the liver:
but this concurrence does not often take
place ; and the diabetes frequently occurs
feparately from any affe&ion of the liver.
In twenty inftances of diabetes which I
Vol. IV. G have
7
go PRACTICE
have feen, there was not in any one of them
any evident affedlion of the liver.
The explanation that has been offered of
the nature and operation of the bile, in
producing diabetes, is very hypothetical,
and nowife fatisfying.
MDXII.
As I have already faid, I think it pro-
bable, that in moft cafes the proximate
caufe of this difeafe is fome fault in the af-
fimilatory powers, or in thofe employed in
converting alimentary matters into the
proper animal fluids. This I formerly
hinted to Dr Dobfon, and it has been pro-
fecated and publifhed by him ; but I mutt
own, that it is a theory embarrafled with
fome difficulties which I cannot at prefent
very well remove.
MDXIH.
OF PHYSIC. 91
MDXIH.
The proximate caufe of diabetes being
io little known or ascertained, 1 cannoc
propoie any rational method of cure in the
difeafe. From die teftimony of feveral au-
thors, I believe that the difeafe has been
cured: but I believe alfo, that this has fel-
dom happened; and when the difeafe has
been cured, I doubt much if it was effected
by the feveral remedies to which thefe cures
have been afcribed. In all the inftances
of this difeafe which I myfelf have feen,
and in feveral others of which I have been
informed, no cure of it has ever been made
in Scotland, though many inftances of it
have occurred, and in mod of them the
remedies recommended by authors have
been diligently employed. I cannot, there-
fore, with any advantage, enter into a de-
tail of thefe remedies ; and as the difeafe,
together with its feveral circumflances,
G 2 when
92 PRACTICE
when they fhall hereafter occur, is likely
to become the fubjedl of diligent invefti-
gation, 1 avoid going farther at prefent,
and judge it prudent to fufpend my opi-
nion till I mall have more obfervations
and experiments upon which I can form it
more clearly.
CHAP.
OF PHYSIC. 93
CHAP. XIII.
Of the Hysteria, or the Hysteric
Disease.
MDXIV.
THE many and various fymptoms
which have been fuppofed to belong
to a difeafe under this appellation, render
it extremely difficult to give a general cha-
racter or definition of it. It is, however,
proper in all cafes to attempt fome general
idea ; and therefore, by taking the mofl
common form, and that concurrence of
G 3 fymp-
94 PRACTICE
fymptoms by which ic is principally di-
flinguifhed, 1 have formed a character in
my fyftem of Methodical Nofology, and
fliall here endeavour to illuftrate it by gi-
ving a more full hiftory of the pheno-
mena.
MDXV.
The difeafe attacks in paroxyfms or fits.
Thefe commonly begin by fome pain and
fulnefs felt in the left fide of the belly.
From this a ball feems to move with a
grumbling noife into the other parts of
the belly; and, making as it were various
convolutions there, feems to move into the
ftomach ; and more diftindtly ftill rifes up
to the top of the gullet, where it remains
for fome time, and by its preffure upon
the larynx gives a fenfe of fufFocation. By
the time that the difeafe has proceeded
thus far, the patient is affected with a ftu-
por
O F P II Y S I C. 95
por and infenfibility, while at the fame
time the body is agitated with various con-
vuliions. The trunk of the body is wreath-
ed to and fro, and the limbs are varioufly
agitated ; commonly the convulfive mo-
tion of one arm and hand, is that of beat-
ing, with the clofed fift, upon the bread
very violently and repeatedly. This ftate
continues for fome time, and has during
that time fome remilfions and renewals of
the convulfive motions; but they at length
ceafe, leaving the patient in a ftupid and
feemingly fleeping ftate. More or lefs fud-
denly, and frequently with repeated figh-
ing and fobbing, together with a murmur-
ing noife in the belly, the patient returns
to the exercife of fenfe and motion, but
generally without any recollection of the *u
feveral circumftances that had taken place TV
during the fit, y ^— <~
a 4 mdxvi/ ■•"■
96 PRACTICE
MDXVI.
This is the form of what is called an
byjleric paroxyfm, and is the mod common
form ; but its paroxyfms are considerably
varied in different perfons, and even in the
fame perfon at different times. It differs,
by having more or fewer of the circum-
ftances above mentioned; by thefecircum-
flances being more or lefs violent; and by
the different duration of the whole fie.
Before the fit, there is fometimes a fud-
den and unufually large flow of limpid
urine. At the coming on of the fit, the
ftomach is fometimes affected with vomit-
ing, the lungs with considerable difficulty
of breathing, and the heart with palpita-
tions. During the fit, the whole of the
belly, and particularly the navel, is drawn
ftrongly inwards ; the Sphincter ani is
fometimes fo firmly conftricled as not to ad-
mit a fmall glyfter-pipe, and there is at the
fame
O F P H Y S 1 C. 97
fame time an entire fuppreflion of urine.
.Such fits are, from time to time, ready to
recur; and during the intervals, the pa-
tients are liable to involuntary motions, to
lies of laughing and crying, with fudden
tranfition from the one to the other ; while
fometimes falfe imaginations, and fome
degree of delirium, alfo occur.
MDXVII.
Thefe affections have been fuppofed pe-
culiar to the female fex ; and indeed they
moft commonly appear in females : but
they fometimes, though rarely, attack alfo
the male fex ; never, however, that I have
obferved, in the fame exquifite degree.
In the female fex, the difeafe occurs efpe-
cially from the age of puberty to that of
thirty-five years ; and though it does fome-
times, yet very feldom appears before the
former or after the latter of thefe periods.
At
98
PRACTICE
At all ages, the time at which it mod
readily occurs is that of the menftrual pe-
riod.
The difeafe more efpecially affedls the
females of the moll exquifitely fanguine
and plethoric habits, and frequently affe&s
thofe of the mod robuft and mafculine
conftitutions.
It affe&s the barren more than the
breeding women, and therefore frequently
young widows.
It occurs efpecially in thofe females who
are liable to the Nymphomania ; and the
Nofologifts have properly enough marked
one of the varieties of this difeafe by the
title of Hyjlcria Libidinofa.
In the perfons liable to the fits of this
difeafe, it is readily excited by the paf-
fions of the mind, and by every confider-
able emotion, efpecially thofe brought on
by furprife.
The perfons liable to this difeafe ao*
quire
O F P II Y S I C. 99
quire often fuch a degree of fenfibility, as
to be ftrongly aflecled by every impreflior*
that comes upon them by furprife.
MDXVIII.
In this hiftory, there appears to be a
concurrence of fymptoms and circumftan-
ces properly marking a very particular
difeafe, which I think may be diftinguifh-
ed from all others. It feems to me to
have been improperly confidered by phy-
ficians as the fame with fome other difea-
fes, and particularly with hypochondria-
lis. The two difeafes may have fome
fymptoms in common, but for the mod
part are considerably different.
Spafmodic affedions occur in both dif-
eafes ; but neither fo frequently nor to fo
great a degree, in hypochondriasis as in
hyftcria.
Perfons liable to hyfteria are fometimes
afFecled
ioo PRACTICE
affected at the fame time with dyfpepfia.
They are often, however, entirely free
from it ; but I believe this never happens
to perfons affedted with hypochondriafis.
Thefe different circumftances mark fome
difference in the two difeafes ; but they
are ftill more certainly diftinguifhed by
the temperament they attack, and by the
^ '-} time of life at which they appear to be
3i *<*<*+ t^y- moft exquifitely formed.
*jLJ(< fu <?— It has been generally fuppofed, that the
(%"kl L two difeafes differ only in refpecl of their
^>^^^>*^ppearing in different fexes. But this is
*&j£*- not well founded : for although the hy-
fteria appears mod commonly in females,
the male fex is not abfolutely free from it,
as I have obferved above; and although
the hypochondriafis may be moft frequent
in men, the inftances of it in the female
fex are very common,
MDXIX.
OF PHYSIC. lot
MDXIX.
From all thefe confiderations, it muft, I
think, appear, that the hyfteria may be
very well, and properly, diftinguifhed
from hypochondriafis.
Further, it feems to me to have been
with great impropriety, that almoft every
degree of the irregular motions of the
nervous fyftem has been referred to the
one or other of thefe two difeafes. Both
are marked by a peculiarity of tempera-
ment, as well as by certain fymptoms
commonly accompanying that ; but fome
of thefe, and many others ufually marked
by the name of nervous fymptoms, may,
from various caufes, arife in tempera-
ments different from that which is pecu-
liar to either hyfteria or hypochondriafis,
and without being joined with the pecu-
liar fymptoms of either the one or the
other difeafe : fo that the appellations of
Hyfteric
A
102 PRACTICE
Hyfteric and Hypochondriac are very in-
accurately applied to them. Under what
view thefe fymptoms are otherwife to be
confidered, I am not ready to determine \
but muft remark, that the appellation of
Nervous Difeafes is too vague and unde-
fined to be of any ufeful application.
MDXX.
Having thus endeavoured to diftinguilli
hyfteria from every other difeafe,I fhall now
attempt its peculiar pathology. With re-
fpe<fl to this, I think it will, in the flrft
place, be obvious^ that its paroxyfms be-
gin by a convuHive and fpafmodic affec-
tion of the alimentary canal, which is af-
terwards communicated to the brain, and
to a great part of the nervous fyftem.
Although the difeafe appears to begin in
the alimentary canal, yet the conne&ion
which the paroxyfms fo often have with
i the
i
OF PHYSIC. 103
the menflrual flux, and with the difeafes
that depend on the ftate of the genitals,
fhows, that the phyficians have at all times
judged rightly in confidering this difeafe
as an affection of the uterus and other a
parts of the genital fyftem. U<t'<~ *f ;U tfa**,
MDXXI.
With regard to this, however, I can go
no farther. In what manner the uterus,
and in particular the ovaria, are afFedled
in this difeafe; how the afFe&ion of thefe
is communicated, with particular circum-
ftances, to the alimentary canal ; or how
the affe&ion of this, riiing upwards, af-
fedls the brain, fo as to occafion the par-
ticular convulfions which occur in this
difeafe ; I cannot pretend to explain.
But although I cannot trace this difeafe
to its firft caufes, or explain the whole of
the phenomena ; I hope, that with refpecfl
to
i04
Practice
to the general nature of the difeafe, I may
form fome general conclufions, which may
ferve to direct our condudt in the cure of
it.
MDXXII.
Thus from a confideration of the pre-
difponent and occafional caufes, it will, I
think, appear, that the chief part of the
proximate caufe is a mobility of the fy-
ftem, depending generally upon its pletho-
ric ftatc\
MDXXllt.
Whether this difeafe ever arifes from a
mobility of the fyftem, independent of any
plethoric ftate of it, I cannot pofitively
determine ; but in many cafes that have
fubfifted for fome time, it is evident that
a fenfibility, and confequently a mobility,
are
i
OF PHYSIC. 105
are acquired, which often appear when
neither a general plethora can be fuppofed
to fubfift, nor an occafional turgefcerice
to have happened. However, as we have
fhown above, that a diftention of the vef-
fels of the brain feems to occafion epilep-
fy, and that a turgefcence of the blood in
the veflels of the lungs feems to produce
afthma ; fo analogy leads me to fuppofe,
that a turgefcence of blood in the uterus,
or in other parts of the genital fyftem,
may occafion the fpafmodic and convul-
five motions which appear in hyfleria. It
will, at the fame time, be evident, that
this affe&ion of the genitals muft efpe-
cially occur in plethoric habits ; and eve-
ry circumftance mentioned in the hiftory
of the difeafe ferves to confirm this opinion
with refpedt to its proximate caufe.
Vol. IV. H MDXXIV.
io6 PRACTICE
MDXXIV.
From this view of the fubject, the ana-
logy of hyfteria and epilepfy will readily
appear ; and why, therefore, I am to fay
that the indications of cure are the fame
in both.
As the indications, fo the feveral means
of anfwering them are fo much the fame
in both difeafes, that the fame obfervations
and directions, with regard to the choice
and employment of thefe remedies, that
have been delivered above on the fubjecSi
of epilepfy, will apply pretty exadlly to
hyfteria ; and therefore need not be re-
peated here.
CHAP,
O F P H Y S I C. 107
CHAP. IX.
Of CanineMadness and Hydrophobia
A^S R 'W'/*k/.
MDXXV.
THIS difeafe has been fo exadlly and
fully defcribed in books that are in A
everybody's hands, that it is on no ac-^^2 /;
count neceflary for me to give any hiftory
of it here ; and with refpecfl to the patho-
logy of it, I find chat I can fay nothing
fatisfying to myfelf, or that I can expedl
to prove fo to others. I find alfo, with re-
H 2 fpeft
io8- PRACTICE
fped to the cure of this difeafe, that there
is no fubjedt in which the fallacy of expe-
rience appears more ftrongly than in this.
From the mod ancient to the prefent
times, many remedies for preventing and
curing this difeafe have been recommend-
ed under the fandtion of pretended ex-
perience, and have perhaps alfo kept their
. V ~ credit for fome time : but fucceeding
^^^j^uume& have generally, upon the fame
4~~Jh ^~ ^^ ground of experience, deftroyed that cre-
dit entirely ; and mod of the 'remedies
formerly employed are now fallen into
abfolute negledh In the prefent age, fome
new remedies have been propofed, and
have experience alleged to vouch for their
efficacy ; but many doubts ftill remain
with refpedl to this : and though I can-
not determine in this matter from my
own experience, I think it incumbent
on me to give the beft judgment I can
form
O F P H Y S I C. 109
form with refpcft to the choice of the re-
medies at prefent recommended.
MDXXVI.
I am, in the firft place, firmly perfua-
ded, that the mod certain means of pre-
venting the confequences of the bite, is to
cut out, or otherwife deftroy, the part in
which the bite has been made. In this
every body agrees ; but with this differ-
ence, that fome are of opinion that it can
only be effectual when it is done very foon
after the wound has been made, and they
therefore negledl it when this opportunity
is miffed. There have been, however, no
experiments made proper to determine this
matter : and there are many confidera-
tions which lead me to think, that the
poifon is not immediately communicated
to the fyftem ; and therefore, that this
meafure of deftroying the part may be
H3 praSifed- ^
no PRACTICE
pra&ifed with advantage, even many days
tflf^CCS after the bite has been given.
4+^ Lfr-t-tA** A^iU^t
^J^U MDXXVII.
^2? ^Z2*"*' Wkilft t^ie ftate°f our experience, with
j*efpedl to feveral remedies now in ufe, is
uncertain, I cannot venture to afTert that
any of thefe is abfolutely ineffectual ; but
^ I can give it as my opinion, that the effi-
IH2L f ^^Jcacy of mercury, given very largely, and
jZTZd-l*^' perfifted in for a long time, both as a
SL— 7^^means °f preventing the difeafe, and of
~ *"*14L l>£~ c.ur*ng ll when it has actually come on, is
sJul W~~^~ better fupported by experience than that
*~ j^ dl^ of any other remedy now propofed or
fcU-&»~2jfts* commonv employed.
BOOK
BOOK IV.
O F
V E S A N I JE,
OR OF THE
DISORDERS of the INTELLECTUAL
FUNCTIONS.
CHAP. I.
Of Vesani^e in General,
f
MDXXVIII.
THE Nofologifts, Sauvages and Sagar,y,^y/v^^^y
in a clafs of difeafes under the title ^ £~T^ ~~
of Vesani-e, have comprehended the two ££^pu~
H4 orders; JT *"S
' / < // ~
U2 PRACTICE
orders, of Hallucinationes or Falfe Percep-
tions, and of Morofitates or Erroneous Ap-
petites and Paflions ; and in like manner,
Linnaeus in his clafs of Mentales, cor-
refponding to the Vefaniae of Sauvages, has
comprehended the two orders of Imagina-
rii and Pathetici, nearly the fame with the
Hallucinationes and Morofitates of that au-
thor. This, however, from feveral con-
fiderations, appears to me improper ; an$
I have therefore formed a clafs of Vefanias
nearly the fame with the Paranoias of Vo-
gel, excluding from it the Hallucinationes
and Morofitates, which I have referred to
the Morbi Locales. Mr Vogel has done the
like, in feparating from the Paranoias the
falfe perceptions and erroneous appetites ;
and has thrown thefe into another clafs,
to which he has given the title of Hype-
raefthefes*
MDXXIXc
OF PHYSIC. ii J
MDXXIX.
It is indeed true, that certain hallucina-
tions and morofitatcs are frequently com-
bined with what I propofe to confider as
ftriftly a vefania or an erroneous judge-
ment ; and fometimes the hallucinationes
feem to lay the foundation of, and to form
almoft entirely, the vefania. But as moft
part of the hallucinationes enumerated by
theNofologifts are affecftions purely topical,
and induce no other error of judgment be-
fide that which relates to the fingle objecfl
of the fenfe or particular organ affedled ;
fo thefe are certainly to be feparated from
the difeafes which confift in a more general
affection of the judgment. Even when the
hallucinationes conftantly accompany or
feem to induce the vefania, yet being fuch
as arife from internal caufes, and may be
prefumed to arife from the fame caufe as
the more general affeflion of the judgment,
they
ii4 PRACTICE
they are therefore to be confidered as
fymptoms of this only.
In like manner I judge with refpedl to
the morofitates, or erroneous paffions*, that
accompany vefania; which, as confequen-
ces of a falfe judgment, muft be confidered
as arifing from the fame caufes, and as
fymptoms only, of the more general affec-
tion.
There is, indeed, one cafe of a morofitas
which feems to induce a vefania, or more
general affecftion of the judgment ; and this
may lead us to confider the vefania, in this
cafe, as a fymptom of an erroneous appetite,
but will not afford any good reafon for com-
prehending the morofitates in general under
the vefania, confidered as primary difeafes.
The limitation, therefore, of the clafs of
Vefaniae to the lefions of our judging fa-
culty, feems from every confideration to be
proper.
The particular difeafes to be compre-
hended
OF P II Y S I C ii5
hendcd under this clafs, may be diflin-
guiihed according as they aired perfons in
the time of waking or ileeping. Thofe
which affeit men awake, may again be
confidered, as they confifl in an erroneous
judgment, to which I fhall give the appel-
lation of Delirium; or as they confift in a
weaknefs or imperfedlion of judgment,
which I (hall name Fatuity. I begin with
the confideration of Delirium,
MDXXX.
As men differ greatly in the foundnefs
and force of their judgment, fo it may be
proper here to afcertain more precifely
what error or imperfection of our judging
faculty is to be confidered as morbid, and
to admit of the appellations of Delirium
and Fatuity. In doing this, I fhall firfl
confider the morbid errors of judgment
under the general appellation of Delirium,
which
n6 PRACTICE
which has been commonly employed to
denote every mode of fuch error.
MDXXXI.
As our judgment is chiefly exercifed in
difcerning and judging of the feveral rela-
tions of things, I apprehend that delirium
may be defined to be, — In a perfon a-
wake, a falfe or miftaken judgment of
thofe relations of things, which, as oc-
curring moft frequently in life, are thofe
about which the generality of men form
the fame judgment ; and particularly when
the judgment is very different from what
the perfon himfelf had before ufually
formed.
MDXXXII.
With this miftaken judgment of rela-
tions there is frequently joined fome falfe
per-
OF PHYSIC. ri7
perception of external objects, without any
evident fault in the organs of fenfe, and
which feems therefore to depend upon an
internal caufe; that is, upon the imagina-
tion arifing from a condition in the brain
prefenting objects which are not actually
prefent. Such falfe perceptions mufl ne-
ceflarily occafion a delirium, or an erro-
neous judgment, which is to be confidered
as the difeafe.
MDXXXIII.
Another circumftance, commonly at-
tending delirium, is a very unufual aflb-
ciation of ideas. As, with refpedl to moft
of the affairs of common life, the ideas
laid up in the memory are, in moft men,
affociated in the fame manner ; fo a very
unufual affociation, in any individual,
mufl prevent his forming the ordinary
judgment of thofe relations which are the
4 mod
n8 PRACTICE
moft common foundation of afTociation in
the memory : and therefore this unu-
fual and commonly hurried afTociation of
ideas, ufually is, and may be confidered
as, a part of delirium. In particular it
may be confidered as a certain mark of a
general morbid aflfe&ion of the intellec-
tual organs, it being an interruption or
perverfion of the ordinary operations of
memory, the common and neceflary
foundation of the exercife of judge-
ment,
MDXXXIV.
A third circumftance attending delirium,
is an emotion or paffion, fometimes of the
angry, fometimes of the timid kind ; and
from whatever caufe in the perception or
judgment, it is not proportioned to fuch
caufe, either in the manner formerly cuf-
tomary to the perfon himfelf, or in the
4 manner
O 9 P II Y B I C. 119
manner ufaal with the generality of other
men.
MDXXXV.
Delirium, then, may be more fhortly
defined, — In a perfon awake, a falfe judge-
ment arifing from perceptions of imagina-
tion, or from falfe recollection, and com-
monly producing difproportionate emo-
tions.
Such delirium is of two kinds ; as it is
combined with pyrexia and comatofe af-
fections ; or, as it is entirely without any
fuch combination. It is the latter cafe
that we name Infanity ; and it is this kind
of delirium only that I am to treat of
here.
MDXXXVr.
Infanity may perhaps be properly con-
fidered
120 PRACTICE
/
fidered as a genus comprehending many
different fpecies, each of which may de-
ferve our attention ; but before proceeding
to the confideration of particular fpecies, I
think it proper to attempt an inveftigation
of the caufe of infanity in general.
MDXXXVII.
In doing this, I fliall take it for granted,
as demonftrated elfewhere, that although
this difeafe feems to be chiefly, and fome-
times folely, an affeiftion of the mind ; yet
the conne&ion between the mind and bo-
dy in this cafe is fuch, that thefe affedlions
of the mind muft be confidered as de-
pending upon a certain ftate of our corpo-
real part. See Halleri Prim. Lin. Phyfio-
log. § dlxx. See Boerhaavii Inft. Med.
§DLXXXI. DCXCVI,
MDXXXVIII.
OF PHYSIC. i2!
MDXXXV1II.
Admitting this propofition, I mud in the
next place ailume another, which 1 like-
wife fuppofe to be demonstrated elfewhere.
This is, that the part of our body more
immediately connected with the mind,
and therefore more efpecially concerned in
every affe&ion of the intellectual func-
tions, is the common origin of the nerves ;
which I fliall, in what follows, fpeak of
under the appellation of the Brain.
MDXXXIX.
Here, however, in afluming this laft
propofition, a very great difficulty imme-
diately prefents itfelf. Although we cannot
doubt that the operations of our intellect
always depend upon certain motions ta-
king place in the brain, (fee Gaub. Path.
Med. § 523 ) ; yet thefe motions have ne-
Vol. IV. I ver
122 PRACTICE
ver been the objedls of our fenfes, nor haye
we been able to perceive that any particu-
lar part of the brain has more concern in
the operations of our intellect than any o-
ther. Neither have we attained any know-
ledge of what fhare the feveral parts of the
brain have in that operation; and there-
fore, in this fituation of our fcience, it
mull be a very difficult matter to difcover
thofe ftates of the brain that may give oc-
cailon to the various ftate of our intellec-
tual functions.
MDXL.
It may be obferved, that the different
ftate of the motion of the blood in the vef-
fels of the brain has fome fhare in afte&ing
the operations of the intellect; and phyfi-
cians, in feeking for the caufes of the dif-
*/ /v— /**k<~
ferent ftates of our intelledual fundions,
have hardly looked further than into the
ftate
O F P II Y S I C. 123
ftate of the motion of the blood, or into the
condition of the blood itfclf : but it is evi-
dent that the operations of the intellectual
fun&ions ordinarily go on, and are often
considerably varied, without our being able
to perceive any difference either in the mo-
tions or in the condition of the blood.
MDXLI.
Upon the other hand, it is very probable
that the ftate of the intellectual functions
depends chiefly upon the ftate and condi-
tion of what is termed the Nervous Power,
or, as we fuppofe, of a fubtile very move-
able fluid, included or inherent, in a man-
ner we do not clearly underftand, in e-
\ery part of the medullary fubftance of the
brain and nerves, and which in a living
and healthy man is capable of being mo-
ved from every one part to every other of
the nervous fyftem.
I 2 MDXLII.
*
124 PRACTICE
MDXLII.
With refpecfl to this power, we have
pretty clear proof that it frequently has a
motion from the fentient extremities of the
nerves towards the brain, and thereby pro-
duces fenfation ; and we have the fame
proof, that in confequence of volition the
nervous power has a motion from the brain
into the mufcles or organs of motion. Ac-
cordingly, as fenfation excitfes our intellec-
tual operations, and volition is the effedt of
thefe, and as the conne&ion between fen-
fation and volition is always by the inter-
vention of the brain and of intellectual o-
perations ; fo we can hardly doubt, that
thefe latter depend upon certain motions,
and the various modification of thefe mo
tions, in the brain.
f
OF PHYSIC, i2£
MDXLIII.
To afcertain the different dates of thcfe
motions may be very difficult; and phy-
ficians have commonly confidered it to be
fo very myfterious, that they have gene-
rally defpaired of attaining any knowledge
with regard to it : but I confider fuch ab-
lolute defpair, and the negligence it in-
ipires, to be always very blameable ; and I
fliall now venture to go fome length in the
inquiry, hoping that fome fteps made with
tolerable firmnefs may enable us to go ftill
further.
MDXLIV.
To this purpofe, I think it evident, that
the nervous power, in the whole as well as
in the feveral parts of the nervous fyftem,
and particularly in the brain, is at diffe-
rent times in different degrees of mobility
1 3 and
126 PRACTICE
and force. To thefe different ftates, I beg
leave to apply the terms of Excitement and
Collapfe. To that ftate in which the mo-
bility and force are fufficient for the exer-r
cife of the fun<flions, or when thefe dates
are any way preternaturally increafed, I
give the name of Excitement ; and to that
ftate in which the mobility and force are
not fufficient for the ordinary exercife of
the fundlions, or when they are diminifh-
ed from the ftate in which they had been
before, I give the name of Collapfe. 1 beg,
however, it may be obferved, that by thefe
terms I mean to exprefs matters of fa<ft
only ; and without intending, by thefe
terms, to explain the circumftance or con-
dition, mechanical or phyfical, of the ner-
vous power or fluid in thefe different ftate?,
MDXLV
L
OF PHYSIC. 127
MDXLV.
That thefe different ftates of excitement
and collapfe take place on different occa-
sions, mull, 1 think, be manifeft from
numberlefs phenomena of the animal oe-
conomy: but it is cfpecially to our prefent
purpofe to obferve, that the different ftates
01 excitement and collapfe, are in no in-
ftance more remarkable, than in the dif-
ferent ftates of waking and fleeping. In
the latter, when quite complete, the mo-
tion and^obility of the nervous power,
with refpeft to the whole of what are call-
ed the Animal Functions, entirely ceafe,
or, as I would exprefs it, are in a ftate of
collapfe; and are very different from the
liate of waking, which in healthy perfons
I would call a ftate of general and entire
excitement.
I 4 MDXLVL
128 PRACTICE
MDXLVI.
This difference in the ftates of the ner-
vous power in fleeping and waking being
admitted, I muft in the next place ob-
ferve, that when thefe dates are changed
from the one into the other, as commonly
happens every day, the change is hardly
ever made inftantaneoufly, but almofl al-
ways by degrees, and in fome length of
time only : and this may be obferved
with refpedl to both fenfe and motion.
Thus when a perfon is falling afleep, the
fenfibility is gradually diminifhed: fo that,
although fome degree offleep has come on,
flight impreilions will excite fenfation, and
bring back excitement; which the fame,
or even ftronger impreffions, will be inef-
ficient to produce when the (late of fleep
has continued longer, and is, as we- may
fay, more complete. In like manner, the
power of voluntary motion is gradually
di-
O F P H Y S I C. 129
diminiflicd. In fomc members it fails
fooner than in others ; and it is fome time
before it becomes general and considerable
over the whole.
The fame gradual progrefs may be re-
marked in a perfon's coming out of fleep:
The ears in this cafe are often awake before
the eyes are opened or fee clearly, and the
fenfes are often awake before the power of
voluntary motion is recovered ; and it is
curious to obferve, that, in fome cafes, fen-
fations may be excited without producing
the ordinary affociation of ideas. See Mem,
de Berlin, 1752.
MDXLVII.
From all this, I think it will clearly
appear, that not only the different ftates
of excitement and collapfe can take place
in different degrees, but that they can
take place in different parts of the brain,
or
i3o PRACTICE
or at leaft, with refped to the different
functions, in different degrees.
As I prefume that almoft every perfon has
perceived the gradual approach of fleeping
and waking, 1 likewife fuppofe every per-
fon has obferved, that, in fuch interme-
diate ftate of unequal excitement, there al-
moft always occurs more or lefs of deli-
'^i^T T f^ ruim> or dreaming, if any body choofes to
^^— -^-call it fo. There are in this ftate falfe
perceptions, falfe aflbciations, falfe judge-
ments, and disproportionate emotions; in
fhort, all the circumftances by which I have
above defined delirium.
This clearly fhows that delirium may
depend, and I fhall hereafter endeavour
to prove that it commonly does depend,
upon fome inequality in the excitement of
the brain ; and that both thefe afTercions
are founded on this, that, in order to the
proper exercife of our intellectual func-
tions, the excitement muft be complete,
an<
O F P H Y S I C. 131
and equal in every pare of the brain. For
though we cannot fay that the veftiges of
ideas are laid up in different parts of the
brain, or that they are in fome meafure
difFufed over the whole, it will follow up-
on either fuppofition, that as our reafoning
our intellectual operations always require
the orderly and exadt rccolle&ion or me-
mory of afTociated ideas; fo, if any part of
the brain is not excited, or not excitable,
that recollection cannot properly take place,
while at the fame time other parts of the
brain, more excited and excitable, may
give falfe perceptions, afTociations, and
judgments.
MDXLV1IL
It will ferve to illuftrate this, that the
collapfe in fleep is more or lefs complete :
or that the fleep, as we commonly fpeak, is
more or lefs profound : and therefore, that
in many cafes, though fleep takes place to a
3 con-
i32 PRACTICE
confiderable degree, yet certain impreflions
do ftill take effect, and excite motions, or, if
you will, fenfations in the brain; but which
fenfations, upon account of the collapfed
ft ate of fo great a part of the brain, are gene-
rally of the delirious kind, or dreams, con-
fifting of falfe perceptions, aflbciations, and
judgments, that would have been corrected
if the brain had been entirely excited.
Every one, I believe, has obferved, that
the molt imperfedt fleeps are thofe chiefly
attended with dreaming ; that dreams,
therefore, moft commonly occur towards
morning, when the complete ftate of fleep is
paffing away; and further, that dreams are
moft commonly excited by ftrong and un-
eafy impreflions made upon the body.
I apprehend it may alfo be an illuftration
of the fame thing, that, even in waking
hours, we have an inftance of an unequal
ftate of excitement in the brain producing
delirium. Such, I think, occurs in the
cafe
OF PHYSIC. 133
cafe of fever. In this, it is manifeft, that
the energy of the brain, or its excitement,
is conliderably diminifhed with refpedt to
the animal functions : and it is according-
ly upon this ground that I have explained
above, in XLV. the delirium which fo
commonly attends fever. To what I have
there faid I (hall here only add, that it
may ferve to confirm my dodlrine, that
the delirium in fever comes on at a cer-
tain period of the difeafe only, and that
we can commonly difcern its approach by
a more than ufual degree of it appearing
in the time of the patient's falling into or
coming out of fleep. It appears, therefore,
that delirium, when it firft comes on in
fever, depends upon an inequality of ex-
citement ; and it can hardly be doubted,
that the delirium which comes at length
to prevail in the entirely weakened ftate of
fevers, depends upon the fame caufe pre-
vailing in a more confiderable degree.
1 MDXLIX.
i34 PRACTICE
MDXL1X.
From what has been now delivered, I
hope it will be fufficiently evident, that
delirium may be, and frequently is, occa-
sioned by an inequality in the excitement
of the brain.
How the different portions of the brain
may at the fame time be excited or collap-
fed in different degrees, or how the ener-
gy of the brain may be in different degrees
of force, with refpect to the feveral animal,
vital, and natural functions, I cannot pre-
tend to explain ; but it is fufficiently evi-
dent in fact, that the brain may be at one
and the fame time in different conditions
with refpe<ft to thefe functions. Thus in
inflammatory difeafes, when by a ftimu-
lus applied to the brain the force of the
vital fun&ions is preternaturally increafed,
that of the animal is either little changed,
or confiderably diminilhed. On the con-
trary,
O F P H Y S I C. 135
trary, in many cafes of mania, the force
of the animal functions depending always
on the brain, is prodigioufly increafed,
while the ftate of the vital function in the
heart is very little or not at all changed.
I muft therefore fay again, that how dif-
ficult foever it may be to explain the me-
chanical or phyfical condition of the brain
in fuch cafes, the fads are fufficient to
fhow that there is fuch an inequality as
may difturb our intellectual operations.
MDL.
I have thus endeavoured to explain the
general caufe of Delirium : which is of two
kinds ; according as it is with, or without,
pyrexia. Of the firft I take no further no-
tice here, having explained it as well as I
could above in XLV.
I proceed now to confider that delirium
which properly belongs to the clafs of Ve-
faniat,
i36 PRACTICE
fania?, and which I fhall treat of under the
general title of Infanity.
MDLI.
In entering upon this fubject, it im-
mediately occurs, that in many inftances
of infanity, we find, upon difle&ion after
death, that peculiar circumftances had ta-
ken place in the general condicion of the
brain. In many cafes, it has been found
of a drier, harder, and firmer confidence,
than what it is ufually of in perfons who
had not been affected with that difeafe.
In other cafes, it has been found in a
more humid, foft, and flaccid ftate ; and
in the obfervations of the late Mr Meckel *,
it has been found confiderably changed in
its
* Memoir, de Berlin pour l'annce 1 764. It appeared in
many inftances of infane perfons, that the medullary
fubftance of the cerebrum was drier, and of a lefs fpe-
cific gravity, than in perfons who had been always of a
found judgment.
OF PHYSIC. 137
its denfity or fpecific gravity. Whether
thefc different dates have been obferved to
be uniformly the lame over the whole of
the brain, I cannot certainly learn ; and I
f uipecl the diffe&ors have not always accu-
rately inquired into this circumftance: but
in feveral inftances, it appears that thefe
ftates had been different in different parts
of the brain ; and inftances of this inequa-
lity will afford a confirmation of our gene-
ral doclrine.
The accurate Morgagni has obferved,
that in maniacal perfons the medullary
portion of the brain is unufually dry,
hard, and firm : And this he had fo fre-
quently obferved, that he was difpofed to
confider it as generally the cafe. But in
moft of the particular inftances which
he has given, it appears, that, for the
moft part, while the cerebrum was of an,
unufually hard and firm confidence, the
cerebellum was of its ufual foftnefs ; and
Vol IV. K in
i33 PRACTICE
in many of the cafes it was unufually fofc
and flaccid. In fome other cafes, Mor-
gagni obferves, that while a part of the
cerebrum was harder and firmer than or-
dinary, other parts of it were preternatu-
rally foft.
MDL1I.
Thefe obfervations tend to confirm our
generaldocflrine: and there are otherswhich
I think will apply to the fame purpofe.
Upon the difledlion of the bodies of
perfons who had laboured under infanity,
various organic affe&ions have been dif-
covered in particular parts of the brain •
and it is fufficiently probable, that fuch or-
ganic affedtions might have produced a dif-
ferent degree of excitement in the free and
affedted parts, and mud have interrupted
in fome meafure the free communication
between the feveral parts of the brain,
and
OF PHYSIC: 139
and in either way have occafioned infa-
nity.
There have occurred fo many inftances
of this kind, that I believe phyficians are
generally difpofed to fufpecT: organic le-
fions of the brain to exift in almofl every
cafe of infanity,
MDLIII.
This, however, is probably a miftake i
for we know that there have been many
inftances of infanity from which the per-
fons have entirely recovered ; and it is
difficult to fuppofe that any organic le-
fions of the brain had in fuch cafe taken
place. Such tranfitory cafes, indeed, ren-
der it probable, that a ftate of excitement,
changeable by various caufes, had been
the caufe of fuch inftances of infanity.
R 2 MDL1V,
140
PRACTICE
MDLIV.
It is indeed further averted, that in
many inftances of infane perfons, their
brain had been examined after death, with-
out fhowing that any organic lefions had
before fubfifted in the brain, or finding
that any morbid ftate of the brain then
appeared. This, no doubt, may ferve to
fhow, that organic lefidns had not been the
csufe of the difeafe; but it does not afTure
us that no morbid change had taken place
in the brain : for it is probable, that the
difledlors were not always aware of its be-
ing the general condition of hardnefs and
denfity, as different in different parts of
the brain, that was to be attended to, in
order to difcover the caufe of the prece-
ding difeafe ; and therefore many of them
had not with this view examined the ftate
of the brain, as Morgagni feems carefully
to have done.
MDLV
OF i> II Y S I GJ 141
MDLV.
Having thus endeavoured to inveftigate
the caufe of infanity in general, it were
to be wifhed that 1 could apply the doc-
trine to the diflinguiming the feveral
fpecies of it, according as they depend
upon the different ftate and circumftances
of the brain, and thereby to the eftablifli-
ing of a fcientific and accurately adapted
method of cure. Thefe purpofes, how-
ever, appear to me to be extremely diffi-
cult to be attained ; and I cannot hope to
execute them here. All I can do is to
make fome attempts, and offer fome re-
flections, which further obfervation, and
greater fagacity, may hereafter render
more ufefuh
MDLVI.
The ingenious Dr Arnold has been com-
K 3 men-
i42 PRACTICE
mendably employed in diftinguifhing the
different fpecies of infanity as they appear
with refpeel to the mind ; and his labours
may hereafter prove ufeful, when we (hall
come to know fomething more of the dif-
ferent ftates of the brain correfponding to
thefe different ftates of the mind ; but at
prefent I can make little application of his
numerous diftinc\ions. It appears to me
that he has chiefly pointed out and enu-
merated diftindions, that are merely va-
rieties, which can lead to little or no va-
riety of practice : and I am efpecially led
to form the latter conclufion, becaufe thefe
varieties appear to me to be often combi-
ned together, and to be often changed in-
■:o one another, in the fame perfon ; in
whom we muft therefore fuppofe a gene-
ral caufe of the difeafe, which, fo far as
it can be known, muft eftablifh the pa-
thology, and efpecially 'diredt the prac-
tice*
MDLVII,
OF PHYSIC, i43
MDLV1I.
In my limited views of the different
ftates of infanity, I mud go on to confi-
der them under the two heads of Mania
and Melancholia : and though I am fen-
fible that thefe two genera do not com-
prehend the whole of the fpecies of infa-
nity, I am not clear in afligning the other
fpecies which may not be comprehended
under thofe titles. I fhall, however, en-
deavour, on proper occafions as 1 go along,
to point them out as well as I can.
K 4 CHAP.
i44 PRACTICE
CHAP. II.
Of Mania, or Madness.
MDLVI1L
THE circumftances which I have men-
tioned above in MDXXXV. as confli-
cting delirium in general, do more efpe-
cially belong to that kind of it which 1 fhall
treat of here under the title of Mania.
There is fomecimes a falfe perception or
imagination of things prefent that are not;
but this is not a conftant, nor even a fre-
quent, attendant of the difeafe. The falfe
judgment, is of relations long before laid
up in the memory. It very often turns upon
one
O P P II Y S I C. 145
one iinglc fubjecl : but more commonly
the mind rambles from one liibject to
another, with an equally tulle judgment
concerning the mod part of them; and as
at the lame time there is commonly a falfe
allociation, this increafes the confufion of
ideas, and therefore the falfe judgments.
What for the mod part more especially di-
ftinguiilies the difeafe, is a hurry of mind,
in purfuing any thing like a train of
thought, and in running from one train of
thought to another. Maniacal perfons
are in general very irafcible ; but what
more particularly produces their angry
emotions is, that their falfe judgments
lead to fome action which is always pufli-
ed with impetuofity and violence ; when
this is interrupted or reftrained, they break
out into violent anger and furious vio-
lence againft every perfon near them, and
upon every thing that ftands in the way
pf their impetuous will. The falfe judge-
ment
146 PRACTICE
ment often turns upon a miftaken opini-
on of fome injury fuppofed to have been
formerly received, or now fuppofed to be
intended; and it is remarkable, that fuch
an opinion is often with refpedl to their
former deareft friends and relations ; and
therefore their refentment and anger are
particularly directed towards thefe. And
although this fhould not be the cafe, they
commonly foon lofe that refpedl and re-
gard which they formerly had for their
friends and relations. With all thefe cir-
cumftances, it will be readily perceived,
that the difeafe mud be attended very con-
ftantly with that incoherent and abfurd
fpeech we call raving. Further, with the'
circumftances mentioned, there is com-
monly joined an unufual force in all the
voluntary motions ; and an infenfibility
or refinance of the force of all impref-
fions, and particularly a refiftance of the
powers of fleep, of cold, and even of hun-
3 ger;
O F 1' H Y S 1 C. 147
i;vr; though indeed in many inftances a
voracious appetite takes place.
MDLIX.
It appears to me, that the whole of thefe
circumftances and fymptoms point out a
coniiderable and unufual excefs in the ex-
citement of the brain, efpecially with re-
fpeft to the animal functions ; and it ap-
pears at the fame time to be manifeftly in
fome meafure unequal, as it very often
takes place with refpedl to thefe functions
alone, while at the fame time the vital and
natural are commonly very little changed
from their ordinary healthy ftate.
MDLX.
How this excefs of excitement is produ-
ced, it may be difficult to explain. In the
various inftances of what Sauvages has
named
148 PRACTICE
named the Mania Metajlatica^ and in all
the inftances I have mentioned in my No-
fology under the title of the Mania Corpo-
reay it may be fuppofed that a morbid or-
ganic affection is produced in fome part of
the brain ; and how that may produce an
increafed or unequal excitement in certain
parts of it, I have endeavoured to explain
above in MDLII. But I muft at the fame
time acknowledge, that fuch remote cau-
fes of mania have very rarely occurred;
and that therefore fome other caufes of the
difeafe muft be fought for.
The efFe&s of violent emotions or paf-
fions of the mind have more frequently
occurred as the remote caufes of mania ;
and it is fufficiently probable, that fuch
violent emotions, as they do often imme-
diately produce a temperory increafe of
excitement, fo they may, upon fome oc-
calions of their permanent inherence or
frequent repetition, produce a more confir
derable
O F P H Y S I C. 149
derable and more permanent excitement,
that is, a mania.
With refped: to thofe caufes of mania
which ari(e in confequence of a melancho-
lia which had previoufly long fubfifted ;
whether we confider that melancholia as a
partial infanity, or as a long perfifting at-
tachment to one train of thinking, it will
be readily perceived, that in either cafe
fuch an increafe of excitement may take
place in fo confiderable a degree, and in fo
large a portion of the brain, as may give
occafion to a complete mania.
MDLXI.
Thefe confiderations with regard to the
remote caufes appear to me to confirm
fufficiently our general do&rine 01 in-
creafed and unequal excitement in the
mania which I have defcribed above ; but
I mufl own, that I have not exhaufted the
fub-
ISO
PRACTICE
fubjecT;, and that there arc cafes of mank
of which I cannot aflign the remote caufes:
but although I cannot in all cafes explain
in what manner the mania is produced, I
prefume, from the explanation given, and
efpecially from the fymptoms enumerated
above, to conclude, that the difeafe defcri-
bed above depends upon an increafed ex-
citement of the brain; an opinion in which
I am the more confirmed, as I think it will
point out the proper method of cure. At
leaft I think it will moil clearly explain the
operation of thofe remedies, which, fo far
as I can learn from my own experience and
that of others, have proved the mod fuc-
cefsfulin this difeafe; and, to illuftrate this,
I now enter upon the confideration of thefe
remedies, and to make fome remarks upon
the proper manner of employing them.
MDLXIL
OF PHYSIC, 15I
MDLXU.
Retraining the anger and violence of
madmen is always necefTary for prevent-
ing their hurting themfelves or others:
but this reftraint is alfo to be confidered
as a remedy. Angry paffions are always
rendered more violent by the indulgence
of the impetuous motions they produce ;
and even in madmen the feeling of re-
ftraint will fometimes prevent the efforts
which their paffion would otherwife occa-
fion. Reftraint, therefore, is ufeful, and
ought to be complete ; but it fhould be ex-
ecuted in the eafieft manner poffible for
the patient, and the (trait waiftcoat anfwers
every purpofe better than any other that
has yet been thought of. The retraining
madmen by the force of other men, as oc-
casioning a conftant ftruggle and violent
agitation, is often hurtful. Although, on
many occafions, it may not be fafe to al-
low
V
I
152 PRACTICE
V
low maniacs to be upon their legs or to
walk about, it is never defirable to confine
them to a horizontal fituation; and when-
ever it can be admitted, they fhould be
/J^ /*— #^niore or lefs in an eredl pofture.* Altho1
^/^xthere may be no fymptoms of any preter-
^^^^>^/U^^natural fulnefs or increafed impetus of
blood in the vends of the brain, a hori-
zontal poflure always increafes the fulnefs
and tenfion of thefe vefTels, and may there-
by increafe the excitement of the brain.
MDLXIIL
The reftraint mentioned requires con-
finement within doors, and it fhould be in
a place which prefents as few objedls qf
fight and hearing as poflible; and particu-
larly, it fhould be removed from the obje&s
that the patient was formerly acquainted
with, as thefe would more readily call up
ideas and their various affociations. It is
3 for
OF PHYSIC. 153
tor this rcaion that the confinement of
madmen Qiould hardly ever be in their u-
iual habitation | or if they are, that their
apartment fliould be (tripped of all its for-
mer furniture. It is ai'fo for the moll part
proper, that maniacs fliould be without the
company of any of their former acquain-
tance; the appearance of whom common-
ly excites emotions that increafe the dif-
eafe. Strangers may at firft be offenfive ;
but in a little time they come to be objects
either of indifference or of fear, and they
fliould not be frequently changed.
MDLXIV.
Fear being a paflion that diminiflies ex-
citement, may therefore be oppofed to the
excefs of it ; and particularly to the angry
and irafcible excitement of maniacs. Thefe
being more fufceptible of fear than might
be expected, it appears to me to have been
commonly ufeful. In moft cafes it has
Vol. IV. L ap-
J
*54 PRACTICE
appeared to be neceffary to employ a very
conftant impreffion of fear; and therefore
to infpire them with the awe and dread of
fome particular perfons, efpeciallyof thofe
who are to be conftantly near them. This
awe and dread is therefore, by one means
or other, to be acquired ; in the flrft place,
by their being the authors of all the re-
ftraints that may be occafionally proper ;
but fometimes.it may be neceffary to ac-
quire it even by ftripes and blows. The
former, although having the appearance of
more feverity, are much fafer than ftrokes
or blows about the head. Neither of them,
however, mould be employed further than
feems very neceffary, and mould be trufted
only to thofe whofe difcretion can be de-
pended upon. There is one cafe in which
they are fuperfluous ; that is, when the
maniacal rage is either not fufceptible of
fear, or incapable of remembering the ob-
jects of it; for in fuch inftances, ftripes
and
OF PHYSIC; tg$
and blows wouM be wanton barbarity. la
many cafes of a moderate diieaie, it is of
advantage that the perfons who are the au-
thors of reftraiiit and punifhment fhculd
be upon other occafions the beftowers of
every indulgence and gratification that is
admiflible; never, however, negle&ing td
employ their awe when their indulgence, .<- ^ <*<',s>
fhall have led to any abufe. ^/
/
MDLXV.
Although in mania, no particular irri-
tation nor fulnefs of the fyftem feem to be
prefent, it is plain, that the avoiding all
irritation and means of fulnefs is proper ;
and therefore, that a diet neither ftimu-
lating nor nourifhing is commonly to be
employed. As it may even be ufeful to di-»
minim the fulnefs of the fyftem, fo both z
low and a fpare diet is likely in mod cafes
"o be of fervice.
I. 2 MDLXVJ,
ie6 PRACTICE
MDLXVI.
Upon the fame principle, although no
unufual fulnefs of the body be prefent, it
may be of advantage to diminifh even its
ordinary fulnefs by different evacuations.
Blood-letting, in particular, might be
fuppofed ufeful ; and in all recent cafes of
mania it has been commonly pradlifed, and
I think with advantage; but when the dif-
eafe has fubfifted for fome time, I have
feldom found blood-letting of fervice. In
thofe inftances in which there is any fre-
quency or fulnefs of pulfe, or any marks
of an increafed impetus of the blood in the
veffels of the head, blood-letting is a pro-
per and even a neceffary remedy. Some
practitioners, in fuch cafes, have preferred
a particular manner of blood-letting, re-
commending arteriotomy, fcarifying the
hind-head, or opening the jugular vein;
and where any fulnefs or inflammatory
dif-
OF PHYSIC. 157
difpofitton in the veflels of the brain, is
to be fufpecled, the opening of the veflels
nearelt to them is likely to be of the great-
eft fervice. The opening, however, of either
the temporal artery or the jugular vein in
maniacal perfons is very often inconveni-
ent; and it may generally be fufficient to
open a vein in the arm, while the body is
kept in fomewhat of an erect pofture, and
fuch a quantity of blood drawn as nearly
brings on a deliquium animi, which is al-
ways a pretty certain mark of fome dimi-
nution of the fulnefs and tenfion of the
veflels of the brain.
MDLXVII.
For the fame purpofe of taking off the
fulnefs and tenfion of thefe veflels of the
brain, purging may be employed ; and I
can in no other view underftand the ce-
lebrated life of hellebore among the an-
L 3 cients,
158 PRACTICE
cients. I cannot, however, fuppofe any
ipecific power in hellebore; and can by no
means find that, at lead the black helle-
bore, is fo efficacious with us as it is faid to
have been at Anticyra. As coftivenefs,
however, is commonly a very conftant and
hurtful attendant of mania, purgatives
come to be fometimes very neceffary ; and
I have known fome benefit obtained from
the frequent ufe of pretty draftic purga-
tives in this, however, 1 have been fre-
quently difappointed ; and 1 have found
more advantage from the frequent ufe of
pooling purgatives, particularly thefoluble
^^f^kfJtt^^ tartar, than from more draftic medicines.
Jc^UL - MDLXVIIL
Vomiting has alfo been frequently em-
ployed in mania ; and by determining
powerfully to the furface of the body, it
may poffibly diminifli the fulnefs and ten-
sion
L
OF PHYSIC. 159
fion of the vcffels, and thereby the excite-
ment of'the brain; but I have never car-
lied the life of this remedy fo far as might
enable me to judge properly of its effedls.
Whether it may do harm by impelling the
blood too forcibly into the veffels of the
brain, or whether by its general agitation
of the whole fyflem it may remove that in-
equality of excitement which prevails in
mania, 1 have not had experience enough
to determine,
MDLXIX.
Frequent (having of the head has been
found of fervice in mania, and by promo-
ting perfpiration it probably takes off from
the excitement of the internal parts. This,
however, it is likely, may be more effec-
tually done by bliftering, which more cer-
tainly takes off the excitement of fubjacent
parts* In recent cafes it has been found
L 4 ufeful
160 PRACTICE
ufeful by inducing fleep ; and when it has
that effect, the repetition of it may be pro-
per: but in maniacal cafes that have lafted
for fome time, blillering has not appeared to
me to be of any fervice ; and in fuch cafes
alfo 1 have not found perpetual blifters, or
any other form of ilTue, prove ufeful.
MDLXX.
As heat is the principal means of firffe
exciting the nervous fyftem, and eftablifh-
ing the nervous power and vital principle
in animals; fo, in cafes of preternatural
excitement, tne application of cold might
be iuppofed a proper remedy : but there are
many inftances of maniacs who have beea
expofed for a great length of time to a con-
fiderable degree of cold without having
their fymptoms anywife relieved. This
may render in general the application of
cold a doubtful remedy; but it is at the
fame
O E P II Y S I C. i6i
fame time certain, that maniacs have often
I : relieved, and fometimes entirely cu-
red, by the ule of cold bathing^efpecially ^Jf.^V/
when admini tiered in a certain manner.^*^ >~y<y~
This feems to confift, in throwing the mad-
man into the cold water by furprife ; by
detaining him in it for fome length of time;
and, pouring water frequently upon the
head, while the whole of the body except
the head is immerfed in the water ; and
thus managing the whole procefs, fo as
that, with the affiftance of fome fear, a re-
frigerant effecT: may be produced. This, I
can affirm, has been often ufeful ; and that
the external application of cold may be of
fervice, we know further, from the benefit
which has been received in fome maniacal
cafes from the application of ice and fnow
to the naked head, and from the applica-
tion of the noted Clay Cap.
Warm bathing alfo has been recommend-
ed by fome pra&ical writers \ and in fome
rigid
162 PRACTICE
rigid melancholic habits it may poffibly be
ufeful, or as employed in the manner pre-
fcribed by fome, of immerfing the lower
parts of the body in warm water, while
cold water is poured upon the head and
tipper parts. Of this practice, however, I
have had no experience ; and in the com-
mon manner of employing warm bathing
I have found it rather hurtful to maniacs.
MDLXXI.
According to my fuppofition that the
difeafe depends upon an increafed excite-
ment of the brain, efpecially with refpedl
to the animal fundions, opium fo com-
monly powerful in inducing fleep, or a
confiderable collapfe as to thefe fun&ions,
fhould be a powerful remedy of mania.
That it has truly proved fuch, 1 believe
from the teftimony of Bernard Huet,
whofe pra&ice is narrated at the end of
Wep-
O V P II Y S I C. 163
Wepferi Hifloria Apopleclicorum. I leave
to my readers to Itudy this in the work I
have referred to, where every part of the
practice is fully, and, as it appears to me,
very judicioufly delivered. I have never
indeed carried the trial fo far as feems to
be requifite to an entire cure : but I have
frequently employed in fome maniacal
cafes, large dofes of opium ; and when
they had the effect of inducing fleep, it
•was manifeftly with advantage. At the
fame time, in fome cafes, from doubts,
whether the difeafe might not depend up-
on fome organic leflons of the brain, whea
the opium would be fuperfluous ; and in
other cafes, from doubts, whether there
might not be fome inflammatory affection
joined with the mania, when the opium
would be hurtful ; I have never pufhed
this remedy to the extent that might be
neceffary to make an entire cure.
MDJ.XXIL
1 64 PRACTICE
MDLXXII.
$tL~* l^~ *^. Camphire has been recommended as a
^^/Zl^o remedy of mania, and there are inftances
^fvUz*J~^h alleged of its having performed an entire
u~. 0cSX£%l£mt* As ic aPPears from the experiments
> *
*y>^Pj~~^ of Beccaria that this fubftance is poflefled,
£J*><~<^ ^^uof a fedative and narcotic virtue, thefe
t^~.~+~ ~ ^rcures are not altogether improbable : but
^£^V^^*^Ajn feverai trials, and even in large dofes, I
M^j^i^^Jy^}i^yc found no benefit from it; and except-
9~ ^Ti^ *nS thofe m the Philofophical Tranfadions,
Ju^a^^VjL* N° 400. I have hardly met with any other
^/*TV ^Iteftimonies in its favour.
4b^/ y MDLXXI1I.
I have been informed that fome maniacs
have been cured by being compelled to
c#L^-/i/i*^ conftant and even hard labour; and as
(?c^^>J/^C^ a forced attention to the condudt of any
j£u ^^^^jodiiy exercife, is a very certain means of
■frL~*ji —> L^- fty *^~*i£-*c> to *^+->4-4~*j £-0 - divert-
O F P H Y S I C. 1C5
diverting the mind from purfuing any
train of thought, it is highly probable that
fuch cxercife may be ufeful in many cafes
of mania.
1 mu ft conclude this fubjeft with obfer-
ving, that even in feveral cafes of complete
mania, I have known a cure take place in
the courfe of a journey carried on for fome Ji~~ /^^^
length of time. / , j^. ^
MDLXXIV.
Thefe are the remedies which have been
chiefly employed in the mania that has been
above defcribed, and I believe they have
been employed promifcuoufly without fup-
pofing that the mania was to be diftin-
guifhed into different fpecies. Indeed I
am not ready to fay howT far it is to be fo
diftinguifhed, but 1 mall offer one obfer-
vation which may pombly merit attention.
Ic appears to me that there are two dif-
ferent
1 56 PRACTICE
ferent cafes of mania that are efpecially
different according to the original tempe-
rament of the perfons whom the difeafe
affedts. It perhaps occurs mod frequently
in perfons of a melancholic or atrabilarian
temperament ; but it certainly does alfo
often occur in perfons of that very oppo-
fite temperament which phyficians have
named the Sanguine. According as the
difeafe happens to occur in perfons of the
one or other of thefe temperaments, I ap-
prehend it may be confidered as of a dif-
ferent nature ; and I believe, that accurate
obfervation, employed upon a fufficienc
number of cafes, would difcern fome pretty
Conftant difference, either of the fymptoms,
or at leaft of the ftate of fymptoms, in the
two cafes. I imagine that fal/e imagina-
tions, particular averfions and refentments,
are more fixed and fteady in the melan-
cholic than in the fanguine ; and that
fome what inflammatory is more common-
17
OF PHYSIC. 167
ly joined with mania in the fanguine than
in the melancholic. If fuch difference,
however, does truly take place, it will be
obvious, that it may be proper to make
fome difference alfo in the practice. I
am of opinion, that in the mania of fan-
guine perfons, blood-letting and other an-
tiphlogiftic meafures are more proper, and
have been more ufeful, than in the melan-
cholic. I likewife apprehend that cold ba-
thing is more ufeful in the fanguine than
in the melancholic : but I have not had
experience enough to afcertain thefe points
with fufficient confidence.
I have only to add this other obferva-
tion, that maniacs of the fanguine tempe-
rament recover more frequently and more
entirely than thofe of the melancholic.
CHAP.
1 68
PRACTICE
CHAP.
III.
Of Melancholy, and other Form;
of Insanity*
MDLXXV.
Tk VIElancholy has been common!;
•*-▼«*• confidered as a partial infanity
and as fuch it is defined in my Nofology
but I now entertain doubts if this be alto-
gether proper. By a partial infanity, I un-
derftand a falfe and miftaken judgment
upon one particular fubjedt, and what r<
lates to it ; whilft, on every other fubjedt,
the perfon affedled judges as the genera-
lity of other men do. Such cafes have
i „ cei
OF PHYSIC.
169
certainly occurred ; but, I believe, few in
which the partial infanity is ftri&ly limi-
ted. In many cafes of general infanity,
there is one fubjecl of anger or fear, upon
which the falfe judgment more particu-
larly turns, or which is at leaft more fre-
quently than any other the prevailing ob-
ject of delirium : and though, from the
inconfiftency which this principal object
of delirium muft produce, there is there-
fore alfo a great deal of infanity with re-
gard to mod other objects ; yet this laffc
is in very different degrees, both in dif-
ferent perfons, and in the fame perfon at
different times. Thus perfons confidered
as generally infane, will, however, at times,
and in fome cafes, pretty conftantly judge
properly enough of prefent circumftances
and incidental occurrences; though, when
thefe objects engaging attention are not
prefented, the operations of imagination
Vol. IV. M may
iyo
PRACTICE
may readily bring back a general confu-
fion, or recall the particular objed of the
delirium. From thefe confiderations, I am
inclined to conclude, that the limits be-
tween general and partial infanity cannot
always be fo exadly affigned, as to deter-
mine when the partial affe&ion is to be
confidered as giving a peculiar fpecies of
difeafe, different from a more general in-
fanity,
MDLXXVI.
When infanity, neither ftridlly partial,
nor entirely nor conftantly general, occurs
in perfons of a fanguine temperament,
and is attended with agreeable, rather
than with angry or gloomy, emotions, I
think fuch a difeafe mud be confidered as
different from the Mania defcribed above ;
ami alfo, though partial, muft be held as
dif-
OF PHYSIC. 171
different from the proper Melancholia to
be mentioned hereafter.
MDLXXVII.
Such a difeafe, as different from thofe
defcribed MDLIV. requires, in my opi-
nion, a different adminiftration of reme-
dies ; and it will be proper for me to take
particular notice of this here.
Although it may be necefTary to re-
ftrain fuch infane perfons as we have men-
tioned MDLXXVI. from purfuing the ob-
jects of their falfe imagination or judge-
ment, it will hardly be requifite to employ
the fame force of reftraint that is necefTary
in the impetuous and angry mania. It will
be generally fufEcient to acquire fome awe
over them, that may be employed, and
fometimes even be necefTary, to check the
rambling of their imagination, and inco-
herency of judgment.
M 2 MDLXXVIII.
i72 PRACTICE
MDLXXVIII.
The reftraint juft now mentioned as ne-
ceffary will generally require the patient's
being confined to one place, for the fake
of excluding the objedls, and more parti-
cularly the perfons, that might excite ideas
conne<5led with the chief objeds of their
delirium. At the fame time, however, if
it can be perceived there are objedls or
perfons that can call off their attention
from the purfuit of their own difordered
imagination, and can fix it a little upon
fome others, thcfe laft may be frequently
prefented to them : and for this reafon, a
journey, both by its having the effedl of
interrupting all train of thought, and
by prefenting objedls engaging attention,
may often be ufeful. In fuch cafes alio,
when the infanity, though more efpecially
fixed upon one miftaken fubjed, is not
confined to this alone, but is further apt to
i ramble
OF PHYSIC. 173
ramble over other fubjeds with incoherent
ideas, I apprehend the confining or forcing
fuch perfons to fome conftant uniform la-
bour, may prove an ufeful remedy.
MDLXX1X.
When fuch cafes as in MDLXVI. oc-
cur in fanguine temperaments, and may
therefore approach more nearly to Phre-
nitic Delirium ; fo, in proportion as the
fymptoms of this tendency are more evi-
dent and confiderable, blood letting and
purging will be the more proper and ne-
ceflary.
MDLXXX.
To this fpecies of infanity, when occur-
ring in fanguine temperaments, whether it
be more or lefs partial, I apprehend that
cold bathing is particularly adapted; while,
M 3 in
174
PRACTICE
in the partial infanity of melancholic per*
fons, as I fhall fhow hereafter, it is hardly
adiniffible.
MDLXXXI.
Having thus treated of a fpecies of infa-
nity, different, in my apprehenfion, from
both the Mania and Melancholia, I pro-
ceed to confider what feems more proper-
ly to belong to this laft.
MDLXXX1I.
The difeafe which I name Melancholia is
very often a partial infanity only. But as
in many inftances, though the falfe ima-
gination or judgment feems to be with re-
fpecfl to one fubjecfl only ; yet it feldom
happens that this does not produce much
inconfiftency in the other intelle&uai
operations : And as, between a very ge-
neral and a very partial infanity, there
are
OF PHYSIC. 175
are all the poflible intermediate degrees ;
fo it will be often difficult, or perhaps im-
proper, to diflinguifh melancholia by the
character of Partial Infanity alone. If I
miftake not, it mud be chiefly diftinguifh-
ed by its occurring in perfons of a melan-
cholic temperament, and by its being al-
ways attended with fomefeemingly ground-
lefs, but very anxious, fear,
MDLXXX1II.
To explain the caufe of this, I muft ob-
ferve, that perfons of a melancholic tem-
perament are for the moft part of a feri-
ous thoughtful difpofition, and difpofed to
fear and caution, rather than to hope and
temerity. Perfons of this cafl are lefs move-
able than others by any impreffions ; and
are therefore capable of a clofer or more
continued attention to one particular ob-
ject, or train of thinking. Tkey are even
M 4 ready
176
PRACTICE
ready to be engaged in a conftant applica-.
tion to one fubjed ; and are remarkably
tenacious of whatever emotions they hap-
pen to be affe&ed with.
MDLXXX1V.
Thefe circumftances of the melancholic
character, feem clearly to fhow, that per-
fons flrongly affedted with it may be rea-
dily feized with an anxious fear ; and that
this, when much indulged, as is natural to
fuch perfons, may eafily grow into a par-
tial infanity.
MDLXXXV.
Fear and deje&ion of mind, or a timid
and defponding difpofition, may arife in
certain ftates, or upon certain occafions of
mere debility : and it is upon this foot-
ing, that I fuppofe it fometimes\o attend
dyfpepfia. But in thefe cafes, I believe
the
OF PHYSIC. 177
the deipondent difpofition hardly ever ari-
fes to a confiderable degree, or proves fo
obftinately fixed as when it occurs in per-
fons of a melancholic temperament. In
thefe lad, although the fear proceed from
the fame dyfpeptic feelings as in the other
cafe, yet it will be obvious, that the emotion
may rife to a more confiderable degree ;
that it may be more anxious, more fixed,
and more attentive; and therefore may ex-
hibit all the various circumftances which I
have mentioned in MCCXXII.to take place
in the difeafe named Hypochondriasis.
MDLXXXVI.
In confidering this fubjedt formerly in
diftinguifhing Dyfpepfia from Hyppchon-
driafis, although the fymptoms affedling
the body be very much the fame in both,
and even thofe affe&ing the mind be fome-
what fimilar, I found no difficulty in di-
ftin-
178 PRACTICE
ftinguifhing the latter difeafe, merely from
its occurring in perfons of a melancholic
temperament. But I muft now acknow-
ledge, that I am at a lofs to determine how
in all cafes hypochondriafis and melancho-
lia may be diftinguifhed from one ano-
ther, whilft the fame temperament is com-
mon to both.
MDLXXXVII.
I apprehend, however, that the diftinc-
tion may be generally afcertained in the
following manner.
The hypochondriafis I would confider
as being always attended with dyfpeptic
fymptoms : and though there may be, at
the fame time, an anxious melancholic fear
arifingfrom the feeling of thefe fymptoms;
yet while this fear is only a miftaken judge-
ment with refpecft to the ftate of the per-
fon's own health, and to the danger to be
from
O F P H Y S I C. 179
from thence apprehended, I would flill
confider the difeafe as a hypochondriafis,
and as dirtincft from the proper melancho-
lia. But when an anxious fear and de-
fpondency arifes from a miitaken judg-
ment with refpedt to other circumttance:;
than thofe of health, and more efpecially
when the perfon is at the fame time with-
out any dyfpeptic fymptoms, every one
will readily allow this to be a difeafe wide-
ly different from both dyfpepfia and hy-
pochondriafis; and it is, what I would
ftri&ly name Melancholia.
MDLXXXVIII.
In this there feems little difficulty : but
as an exquifitely melancholic temperament
may induce a torpor and flownefs in the
adlion of the ftomach, fo it generally pro-
duces fome dyfpeptic fymptoms; and from
thence there may be fome difficulty in di-
ftinguifhing
x8<
PRACTICE
(linguifhing fuch a cafe from hypochon-
driafis. But I would maintain, however,
that when the characters of the tempera-
ment are ftrongly marked ; and more par-
ticularly when the falfe imagination turns
upon other fubjedts than that of health, or
when, though relative to the perfon's own
body, it is of a groundlefs and abfurd
kind ; then, notwithftanding the appear-
ance of fome dyfpeptic fymptoms, the cafe
is (till to be conlidered as that of a melan-
cholia, rather than a hypochondriafis.
MPLXXXIX.
The difeafe of melancholia, therefore,
manifeftly depends upon the general tem-
perament of the body : and although, in
many perfons, this temperament is not at-
tended with any morbid affedlion either of
mind or body ; yet when it becomes ex-
quifitely formed, and is in a high degree,
it
O F P H Y S I C. 181
it may become a difeafe affe&ing both, and
particularly the mind. It will therefore be
proper to confider in what this melancho.
lie temperament efpecially confifts; and to
this purpofe, it may be obferved, that in it
there is a degree of torpor in the motion
of the nervous power, both with refpedt
to fenfation and volition ; that there is a
general rigidity of the fimple folids ; and
that the balance of the fanguiferous fy-
ftem is upon the fide of the veins. But all
thefe circumftances are the diredly oppo-
fite of thofe of the fanguine temperament;
and mud therefore alfo produce an op-
pofite ftate of mind.
MDXC.
It is this ftate of the mind, and the ftate
of the brain correfponding to it, that is the
chief objedt of our prefent confideration.
But what that ftate of the brain is, will
be
182 PRACTICE
be fuppofed to be difficult to explain ;
and it may perhaps feem raili in me to
attempt it.
I will, however, venture to fay, that it is
probable the melancholic temperament of
mind depends upon a drier and firmer
texture in the medullary fubftance of the
brain; and that this perhaps proceeds from
a certain want of fluid in that fubftance,
which appears from its being of a lefler fpe-
cific gravity than ufual. That this ftateof
the brain in melancholia does actually ex-
ift, I conclude, firjl^ from the general rigi-
dity of the whole habit; zn&,fecondlyy from
diffe&ions, mowing fuch a ftate of the
brain to have taken place in mania, which
is often no other than a higher degree of
melancholia. It does not appear to me
any wife difficult to fuppofe, that the fame
ftate of the brain may in a moderate de-
gree give melancholia; and in a higher,
that mania which melancholia fo often
paffcs
O F P H Y S I C. 183
paflfes into ; efpecially if 1 ihall be allowed
further to fuppofe, that either a greater
degree of firmnefs in the fubftance of the
brain may render it fufceptible of a higher
degree of excitement, or that one portion
of the brain may be liable to acquire a
greater firmnefs than others, and confe-
quently give occafion to that inequality of
excitement upon which mania fo much
depends.
MDXCI.
I have thus endeavoured to deliver what
appears to me mod probable with refpedl
to the proximate caufe of melancholia; and
altho' the matter fhould in fome refpeds
remain doubtful, I am well perfuaded that
thefe obfervations may often be employed
to direcfl our pra&ice in this difeafe, asJL
(hall now endeavour to mow.
MD2&1I.
184 PRACTICE
MDXCII.
In moftof the inftances of melancholia^
the mind is to be managed very much in
the fame manner as I have advifed above
with regard to hypochondriafis ; but as in
the cafe of proper melancholia, there is
commonly a falfe imagination or judge-
ment appearing as a partial infanity, it
may be further necefTary in fuch cafes to
employ fome artifices for correcting fuch
imagination or judgment.
MDXC1II.
The various remedies for relieving the
dyfpeptic fymptoms which always attend
hypochondriafis, will feldom be either re-
quifite or proper in melancholia.
There is only one of the dyfpeptic fymp-
toms, which, though there fhould be no
other, is very conftantly prefent in melan-
cholia,
OF PHYSIC. ifr$
cholia, and that is coftivenefs. This it U
always proper and even neceflary to re-
move; and I believe it is-upon this account
that the ufe of purgatives has been found
fo often ufeful in melancholia. Whether
there be any purgatives peculiarly proper
in this cafe, I dare not pofitively determine;
but with fefpeel to the choice of purga-
tives in melancholia, 1 am of the fame o-
pinion that I delivered above on this fame
fubjedl with refpecT: to mania.
MDXCIV.
With refpe<fl to other remedies, I judge
that blood-letting will more feldom be pro-
per in melancholia than in mania ; but
how far it may be in any cafe proper, muft
be determined by the fame confiderations
as in the cafe of mania.
-
Vol. IV. N MBXCV-
t86 PRACTICE
MDXCV.
The cold bathing that I judged to be Co
very ufeful in feveral cafes of infanity, is,
I believe, in melancholia, hardly ever fit to
be admitted; at lead while this is purely a
partial aftedtion,and without any marks of
violent excitement. On the contrary, upon
account of the general rigidity prevailing
in melancholia, it is probable that warm
bathing may be often ufeful.
MDXCVL
With refpedl to opiates which I have
iuppofed might often be ufeful in cafes of
mania, I believe they can feldom be pro-
perly employed in the partial infanities of
the melancholic, except in certain inftances
of violent excitement, when the melancho-
*
Ha approaches nearly to the ftate of mania.
MDXCVII.
OF PHYSIC 187
MDXCVII.
In fuch cafes of melancholia approach-
ing to a (late of mania, a low diet may
fometimes be neceflary ; but as the em-
ploying a low diet almoft unavoidably
leads to the ufe of vegetable food, and as
this in every torpid ftate of the ftomach is
ready to produce fome dyfpeptic fymp-
toms, fuch vegetable food ought, in mode-
rate cafes of melancholia, to be ufed with
fome caution.
Though exercife, as a tonic power, is not
proper either in hypochondriafis or melan-
cholia; yet, with refpeft to Its effefts upon
the mind, it may be extremely ufeful in
both, and in melancholia is to be employ-
ed in the fame manner that I have advifed
above in the cafe of hypochondriafis.
N 2 MDXCV11I.
i88
PRACTICE
MDXCV1II.
Having now delivered my dodlrine
tvith refpedt to the chief forms of infanity,
I fhould in the next place proceed to con-
sider the other genera of Amentia and O-
neirodynia, which in the Nofology I have
arranged under the order of Vefaniae: but
as I cannot pretend to throw much light
upon thefe fubjedls, and as they are feldom
the ob]€<5ls of practice, I think it allowable
for me to pafs them ever at prefent ; and
the particular circumftances of this work
in fome meafure requires that 1 flaould do
fo.
PART
PART III.
O F
CACHEXIES.
MDXCIX.
UNDER this title I propofe to eflablifh
a clafs of difeafefr, which confift in
a depraved ftate of the whole, or of a con-
fiderable part, of the habit of the body,
without any primary pyrexia or neurofis
combined with that ftate.
N 3 MDC,
rifl
190
PRACTICE
MDC.
The term Cachexy has been employed by
Linnaeus and Vogel, as it had been for-
merly by other authors, for the name of a
particular difeafe : but the difeafe to which
thefe authors have affixed it, comes more
properly under another appellation ; and
the term of Cachexy is more properly em-
ployed by Sauvages and Sagar for the
name of a clafs. In this I have followed
the laft-mentioned nofologifts, though I
find it difficult to give fuch a character of
the clafs as will clearly apply to all the fpe-
cies I have comprehended under it. This
difficulty would be ftill greater, if, in the
clafs I have eftablifhed under the title of
Cachexies, I were to comprehend all the
difeafes that thofe other nofologifts have
done; but I am willing to be thought de-
ficient rather than very incorredi. Thofe
difficulties, however, which dill remain in
me-
OF PHYSIC. 191
methodical nofology, mud not affect us
much in a treatife of practice. If I can
here properly diftinguiih and defcribe the
feveral fpecies that truly and mod com-
monly exiit, I fhall be the lefs concerned
about the accuracy of my general clarifi-
cation: though at the fame time this, I
think, is always to be attempted; and J
fhall purfue it as well as 1 can.
N4 BOOK
\
BOOK I,
O *
EMACIATIONS.
MDCL
EMaciation, or a confiderable dimi-
nution of the bulk or plumpnefs of
the whole body, is for the moft part only
a fymptom of difeafe, and very feldom to
be confidered as a primary and idiopathic
affedtion. Upon this account, accord-
ing to my general plan, fuch a fymptom
might
Q F P H Y S I C. 193
might perhaps have been omitted in the
Methodical Nofology : but both the uncer-
tainty of concluding it to be always fymp-
tomatic, and the confiftency of fyflem,
made me introduce into the Nofology, as
others had done, an order under the title
of Marcores ; and this renders it requifite
now to take fome notice of fuch difeafes.
MDCII.
Upon this occafion, therefore, I hope it
may be ufeful to inveftigate the feveral
caufes of emaciation in all the different
cafes of difeafe in which it appears. And
this I attempt, as the fureft means of deter-
mining how far it is a primary, or a fymp-
tomatic affection only ; and even in the
latter view, the inveftigation may be at-
tended with fome advantage.
MDCIII,
194 PRACTICE
MDCIII.
The caufes of emaciation may, I appre-
hend, be referred to two general heads ;
that is, either to a general deficiency of
fluid in the veflels of the body, or to the
particular deficiency of the oil in the cel-
lular texture of it. Thefe caufes are fre-
quently combined together ; but it will be
proper, in the firft place, to confider them
vu 4K^£>U^~t^ feparately.
r^.3 ^s^/r,
A~7~~. #* MDCIV.
As a great part of the body of animals
is made up of veflels filled with fluids,
the bulk of the whole muft depend very
much on the fize of thefe veflels, and the
quantity of fluids prefent in them : and
it will therefore be fufEciently obvious,
that a deficiency of the fluids in thefe vef-
fels muft, according to its degree, occa-
sion
O F PHYSIC. IS9
fion a proportionate diminution of the bulk
of the whole body. This, however, will
appear ftill more clearly, from confidering
that in the living and found body the vef-
fels every where feem to be preternatural-
ly diflended by the quantity of fluids pre-
lent in them ; but being at the fame time
elaftic, and conftantly endeavouring to con-
tract themfelves, they muft on the with-
drawing of the diftending force, or, in o-
ther words, upon a diminution of the
quantity of fluids, be in proportion con-
traded and diminifhed in their fize : And
it may be further obferved, that as each
part of the yafcular fyflem communicates
with every other part of it ; fo every de-
gree of diminution of the quantity of fluid,
in any one part, muft in proportion dimi-
nifh the bulk of the vafcular fyftem, and
confequently of the whole body. Jft^Jl*^^
j96 PRACTICE
MDCV.
The diminution and deficiency of the
fluids may be occafioned by different caufes :
fuch as, firft, by a due quantity of aliments
not being taken in ; or by the aliment
taken in, not being of a fufficiently nutri-
tious quality. Of the want of a due quan-
tity of aliment not being taken into the
body, there is an inftance in the Atrophia
laBantium Sauvagefii, fpecies 3. and many
other examples have occurred of emaciation
from want of food, occafioned by poverty,
and other accidental caufes.
With refpedl to the quality of food, I
apprehend it arifes from the want of nu-
tritious matter in the food employed, that
perfons living very entirely on vegetables
are feldom of a plump and fucculent ha*
bit.
MDCVI,
O F P H Y S I C. 197
MDCVI.
A fecond caufe of the deficiency of fluids
may be, the aliments taken in not being
conveyed to the blood- veffels. This may
occur from a perfon's being affe&ed with
a frequent vomiting ; which, rejecting the
food foon after it had been taken in, muft
prevent the neceffary fupply of fluids to
the blood-veffels.
Another caufe, frequently interrupting
the conveyance of the alimentary matter in-
to the blood- veflels, is an obftru&ion of the
conglobate or lymphatic gkfids of the me-
fentery, through which the chyle muft ne-
ceflTaf ily pafs to the thoracic dudt. Many in-
ftances of emaciation, feemingly depending
upon this caufe, have been obferved by
phyficians, in perfons of all ages, but efpe-
cially in the young. It has alfo been re-
marked, that fuch cafes have moft fre-
quently occurred in fcrophulous perfons,
in
198 PRACTICE
in whom the mefenteric glands are com-
monly affecled wich tumour or obftruc-
L
tion, and in whom, generally at the fame
time, fcrophula appears externally. Hence
the Tabes fcrophulofa Synop. Nofelog. vol. ii,
p. 266.: And under thefe I have put as
fynonimes Tabes glandularis, fp. 1 o. ; 7tf-
bes mefenteric a, fp. 9. ; Scrophula mefen-
terica, fp. 4. ; Atrophia infantilis, fp. 13.5
Atrophia rachitica, fp. 8. ; Tabes rachialgica^
fp. 16. At the fame time, I have fre-
quently found the cafe occurring in per-
fons who did not fhow any external ap*
pearance of fcrophula, but in whom the
mefenteric obftruction was afterwards dis-
covered by diffe&ion. Such alfo I fuppofe
to have been the cafe in the difeafe fre-
quently mentioned by authors under the
title of the Atrophia infantum. This has
received its name from the time of life at
which it generally appears ; but I have
met with inftances of it at fourteen years
3 of
OF PHYSIC.
1 99
of age ascertained by difTedtion. In feve-
ral fuch cafes which I have fcen, the pa-
tients were without any ferophulous ap-
pearances at the time, or at any period of
their lives before.
In the cafe of phthifical perfons, I (hall
hereafter mention another caufe of their
emaciation ; but it is probable that an ob-
ftruclion of the mefenteric glands, which
fo frequently happens in fuch perfons,
concurs very powerfully in producing the
emaciation that takes place.
Although a ferophulous taint may be
the mod frequent caufe of mefenteric ob-
ftructions, it is fufficiently probable that
other kinds of acrimony may produce the ^j^^
fame, and the emaciation that follows. /c*?T^i^^
It may perhaps be fuppofed, that the +^* r /**?*. 7£*
interruption of the chyle's paffing into tfce * ^^JttZ'
blood- veffels may be fometimes owing to^ ^-^^f,^L
a fault of the abforbents on the internal *^w~0 - ^C
furface of the inteflines. This, however. //^
cannot^— &^ /^^
2oo PRACTICE
cannot be readily afcertained : but the in-
terruption of the chyle's palling into the
blood* veffels may certainly be owing to
a rupture of the thoracic dud ; which,
when it does not prove foon fatal, by oc-
cafioning a hydrothorax, mud in a (hon
time produce a general emaciation.
MDCVIL
A third caufe of the deficiency of the
fluids may be a fault in the organs of di-
geftion, as not duly converting the aliment
into a chyle fit to form in the blood- vefiels
a proper nutritious matter. It is not, how-
ever, eafy to afcertain the cafes of ema-
ciation which are to be attributed to this
caufe ; but I apprehend that the emaciation
which attends long fubfifting cafes of dyf-
pepfia, or of hypochondriafis, is to be ex-
plained chiefly in this way It is this which
1 have placed in the Nofology under the
2 title
j
O F P H Y S I C. 2oi
title of the Atrophia Milium ; and of which
the Atrophia ncrvo/a^ Sauv. fp. i. is a pro-
per inltance, and therefore put there as a
fynonime. Bat the other titles of Atrophia
lateralis y Sauv. fp. 15. and Atrophia fen ills ^
Sauv. fp. 11. are not fo properly put there,
as they muft be explained in a different
manner.
MDCVIII.
A fourth caufe of a deficiency of the
fluids in the body, may be exceflive eva-
cuations made from it by different out-
lets ; and Sauvages has properly enume-
rated the following fpecies, which we have
put as fynonimes under the title of Atro-
phia inanitorum ; as, Tabes nutricum, fp. 4.
Atrophia nutricum, fp. 5. Atrophia a leucor-
rhcea, fp. 4. Atrophia ab alvi fluxu, fp 6.
Atrophia a ptyalifmo, fp. 7. and laftly, the
Vol. IV. O "Tabes
aoz PRACTICE
Tabes a fanguijluxu ; which, ic is to be ob-
ferved, may arife not only from fponta-
neous hemorrhagies or accidental wounds,
but alfo'from blood-letting in too large a
quantity, and too frequently repeated,
Upon this fubje<5t it feems proper to
obferve, that a meagre habit of body fre-
quently depends upon a full perfpiration
being conftantly kept up, though at the
fame time a large quantity of nutritious
aliment is regularly taken in.
MDCIX.
Befides this deficiency of fluids from
evacuations by which they are carried
entirely out of the body, there may be a
deficiency of fluid and emaciation in a
confiderable part of the body, by the fluids
being drawn into one part, or colle&ed
into one cavity ; and of this we have an
in-
O F P H Y S I C. 203
inftance in the Tubes H fydiope, Siiuv.
fP.5.
MDCX.
In the Methodical Nofology, among the
other fynonimes of the Atrophia inanitc-
ru?7iy I have fet down the Tabes dor/alls ;
but whether properly or not, I at prefent
very much doubt. In the evacuation con-
fidered as the caufe of .this tabes, as the
quantity evacuated is never fo great as to
account for a general deficiency of fluids
in the body, we muft feck for another ex-
planation of it. And whether the effedls of
the evacuation may be accounted for, either
from the quality of the fluid evacuated, or
from the Angularly enervating pleafure at-
tending the evacuation, or from the eva-
cuation's taking off the tenfion of parts,
the tenfion of which has a Angular power
in fupporting the tenfion and vigour of the
O 2 wholr
204 PRACTICE
whole body, I cannot pofitively determine;
but I apprehend that upon one or other of
thefe fuppofitions the emaciation attending
the tabes dorfalis muft be accounted for ;
and therefore that it is to be confidered as
an inftance of the Atrophia debilium, rather
than of the Atrophia inanitorum.
MDCXI.
A fifth caufe of a deficiency of fluids
and of emaciations in the whole or in a
particular part of the body, may be the
concretion of the f mall veffels, either not
admitting of fluids, or of the fame pro-
portion as before ; and this feems to me
to be the cafe in the Atrophia f emits, Sauv.
Tp. 2. Or it may be a palfy of the larger
trunks of the arteries rendering them
unfit to propel the blood into the fmaller
veffels ; as is frequently the cafe of para-
lytic limbs, in which the arteries are af-
fefled
O V P H Y S I C. ioj
fected as well as the mufcles. The Atro-
phia lis. Sauv. ip. 15. feems to be of
this nature.
MDCXIL
A fecond general head of the caufes of
emaciation I have mentioned in MDCII.
to be a deficiency of oil. The extent and
quantity of the cellular texture in every
part of the body, and therefore how con-
iiderable a part it makes in the bulk of
the whole, is now well known. But this,
fubftance, in different circumftances, is
more or lefs filled with an oily matter ;
and' therefore the balk of ir, and in a
great meafure that of the whole body,
mud be greater or lefs according as this
fubltance is more or lefs filled in that man-
ner. The deficiency of fluids, for a reafon
to be immediately explained, is generally .
accompanied with a deficiency of oil : but
O 3 ph
io6 PRACTICE
phyficians have commonly attended more
to the latter caufe of emaciation than to the
other, that being ufually the moft evident;
and 1 fhall now endeavour to aflign the fe-
veral caufes of the deficiency of oil as it
occurs upon different occafions.
MDCX1II.
The bufinefs of fecretion in the human
body is in general little underftood, and
in no inflance lefs fo than that of the fe-
cretion of oil from blood which does not
appear previoufly to have contained it. It
is poflible, therefore, that our theory of
the deficiency of oil may be in feveral re-
fpedls imperfedt; but there are certain fads
that may in the mean time apply to the
prefent purpofe.
MDCXIV.
Firft, it is probable3 that a deficiency of
oil
OF PHYSIC. 207
oil may be owing to a ftate of the bipod
in animal bodies lefs fitted to afford a fe-
cretion of oil, and confequently to fupply
thewafteof it that is conftantlymade. This
ftate of the blood muft efpecially depend
upon the ftate of the aliments taken in, as
containing lefs of oil or oily matter. From
many obfervations made, both with refpedl
to the human body and to that of other
* animals, it appears pretty clearly, that the
aliments taken in by men and domeftic
animals, according as they contain more of
oil, are in general more nutritious, and in
particular are better fitted to fill the cel-
lular texture of their bodies with oil. I
might illuftrate this, by a minute and par-
ticular confideration of the difference of
alimentary matters employed ; but it will
be enough to give two instances. The one
is, that the herbaceous part of vegetables,
does not fatten animals, fo much as the
O 4 feeds
to8
PRACTICE
feeds of vegetables, which manifeftly con-
tain in any given weight a greater propor-
tion of oil ; and a fecond inftance is, that
in general vegetable aliments do not fat-
ten men fo much as animal food, which
generally contains a larger proportion of
oil.
It will be obvious, that upon the fame
principles a want of food, or a lefs nutri-
tious food, may not only occafion a gene-
ral deficiency of fluids (MDC1V.), but
muft alfo afford lefs oil, to be poured intp
the cellular texture. In fuch cafes, there-
fore, the emaciation produced, is to be at-
tributed to both thele general caufes.
MDCXV.
A fecond cafe of the deficiency of oil
rnay be explained in this manner. It is
pretty manifefl, that the oil of the blood is
fecreted and depofited in the cellular tex-
ture
OF PHYSIC. 209
ture in greater or lefler quantity, accord-
ing as the circulation of the blood is fa-
der or flower: and therfore that excrcife
which haftens the circulation of the blood,
is a frequent caule of emaciation. Exer-
cile produces this effedl in two ways, ift,
By increafing the perfpiration, and thereby
carrying off a greater quantity of the nu-
tritious matter, it leaves lefs of it to be de-
pofited in the cellular texture; thereby
not only preventing an accumulation of
fluids, but, as 1 have faid above, cau-
fing a general deficiency of thefe, which
muft alfo caufe a deficiency of oil in the
cellular texture. 2dly, It is well known,
that the oil depofited in the cellular tex-
ture is upon many occafions, and for va-
rious purpofes of the oeconomy, again ab-
forbed, and mixed or difFufed in the mafs
of blood, to be from thence perhaps car-
ried entirely out of the body by the feve-
jral excretions. Now, among other pur-
pofes
no PRACTICE
pofes of the accumulation and re-abforp-
tion of oil, this feems to be one, that the
oil is requifite to the proper action of the
moving fibres in every part of the body ;
and therefore that nature has provided for
an abforption of oil to be made according
as the a&ion of the moving fibres may de-
mand it. It will thus be obvious, that the
exercife of the mufcular and moving fibres
every where, muft occafion an abforption
of oil; and confequently that fuch exercife
not only prevents the fecretion of oil, as
has been already faid, but may alfo caufe
a deficiency of it, by occafioning an ab-
forption of what had been depofited ; and
in this way, perhaps efpecially, does it
produce emaciation.
MDCXVI.
A third cafe of the deficiency of oil may
occur from the following caufe. It is
probable
OF PHYSIC. 2ij
probable, that one purpofe of the accumu-
lation of oil in the cellular texture of ani-
mals is, that it may, upon occafion, be a-
gain abforbed from thence, and carried in-
to the mafs of blood, for the purpofe of
inveloping and correcting any unufual a-
crimony arifing and exifting in the ftate
of the fluids. Thus, in mod inftances ia
which we can difcern an acrid ftate of tho
fluids, as in fcurvy, cancer, fyphilis, poi-
fons, and feveral other difeafes, we find at
the fame time a deficiency of oil and an
emaciation take place ; which, in my ap-
prehenfion, muft be attributed to the ab-
forption of oil, which the prefence of acri-
mony in the body excites.
It is not unlikely that certain poifons in-
troduced into the body, may fubfift there ;
and, giving occafion to an abforption of
oil, may lay a foundation for the Tabes a
yenenoy Sauv. fp. 17.
MDCXVIL
its PRACTICE
MDCXV1I.
A fourth cafe of emaciation, and which I
would attribute to a fudden and confider-
able abforpcion of oil from the cellular tex-
ture, is that of fever, which fo generally
produces emaciation. This may perhaps
be in part attributed to the increafed per-
foration, and therefore to the general de-
ficiency of fluids that may be fuppofed to
take place : but whatever fhare that may
have in producing the effedl, we can, from
the evident fhrinking and diminution of
the cellular fubftance, wherever it falls un-
der our obfervation, certainly conclude,
that there has been a very confiderable
abforption of the oil which had been be-
fore depofited in that fubftance. This ex-
planation is rendered the more probable
from this, that I fuppofe the abforption
mentioned is necefTarily made for the pur-
pofe of enveloping or correcfling an acri-
mony,
OF PHYSIC. 213
mony, which manifettly does in many,
and may be fafpedted to arife in all, cafes
of fever. The molt remarkable inftance
of emaciation occurring in fevers, is that
which appears in the cafe of heclic fevers.
Here the emaciation may be attributed to
the profufe fweatings that commonly at-
tend the difeafe: but there is much reafon
to believe, that an acrimony alfo is prefent
in the blood ; which, even in the begin-
ning of the difeafe, prevents the fecretion
and accumulation of oil ; and in the more
advanced dates of it, muft occafion a more
confiderable abforption of it ; which, from
the flirinking of the cellular fubitance,
feems to go farther than in almoit any o-
ther inftance.
Upon the fubjecl of emaciations from a
deficiency of fluids, it may be obferved,
that every increafed evacuation excites an
abforption from other parts, and particu-
larly from the cellular texture ; and it is
there-
214 PRACT I«C E
therefore probable, that a deficiency of
fluids, from incrcafed evacuations, produ-
ces an emaciation, not only by the wade
of the fluids in the vafcular fyftem, but
alfo by occafioning a confiderable abforp-
tion from the cellular texture.
MDCXVIII.
I have thus endeavoured to explain the
feveral cafes andcaufes of emaciation; but
I could not profecuce the confideration of
thefe here in the order they are fet down
in the Methodical Nofology. In that work
I was engaged chiefly in arranging the
fpecies of Sauvages; but it is my opinion
now, that the arrangement there given is
erroneous, in both combining and fepara-
ting fpecies improperly : and it feems to
me more proper here to take notice of
difeafes, and put them together, according
to the affinity of their nature, rather than
2 by
j
O F P H Y S I C. *!$
by that of their external appearances. I
doubt, if even the dilHndion of the Tabes
and Atrophia, attempted in the Nofology,
will properly apply ; as 1 think there are
.certain difeafes of the fame nature, which
fometimes appear with, and fometimes
without, fever.
MDCXIX.
After having confidered the various ca-
fes of emaciations, I fhould perhaps treat
of their cure : but it will readily appear,
that the greater part of the cafes above-
mentioned are purely fymptomatic, and
confequently that the cure of them muft
be that of the primary difeafes upon which
they depend. Of thofe cafes that can any-
wife be confidered as idiopathic, it will ap-
pear that they are to be cured, entirely by
removing the remote caufes; the means of
accomplifhing which muft be fufficiently
obvious.
BOOK
216 PRACTICE
BOOK II.
O F
INTUMESCENTI1
O R
GENERAL SWELLINGS,
MDCXX.
THE fwellings to be treated of in this
place are thofe which extend over
the whole or a great part of the body ; or
fuch at lead, as, though of fmall extent,
are however of the fame nature with thofe
that are more generally extended.
3 The
OF PHYSIC. 217
The fwellings comprehended under this
artificial order, are hardly to be- diftin-
guiihed from one another otherwife than
by the matter they contain or confift of:
and in this view I have divided the order
into four feclions, as the fwelling happens
to contain, 1//, Oil ; 2^, Air ; 3^/, A watery
fluid ; or, 4/^, As the increafed bulk de-
pends upon the enlargement of the whole
fubftance of certain parts, and particularly
of one or more of the abdominal vifcera.
Vol. IV. P CHAP,
218 PRACTICE
CHAP. I.
Of Adipose Swellings.
MDCXXI.
THE only difeafe to be mentioned in
this chapter, I have, with other No-
fologifts, named Polyfarcia ; and in Englifh
it may be named Corpulency, or, more
ftridtly, Obefity; as it is placed here upon
the common fuppofition of its depending
chiefly upon the increafe of oil in the cellu-
lar texture of the body. This corpulency,
or obefity, is in very different degrees in
dif-
O F P H Y S I C. 219
different perfons, and is often confiderable
without being coniidered as a difeafe.
There is, however, a certain degree of it,
which will be generally allowed to be a
difeafe; as, for example, when it renders
perfons, from a difficult refpiration, un-
eafy in themfelves, and, from the inabi-
lity of exercife, unfit for difcharging the
duties of life to others : and for that rea-
fon 1 have given fuch a difeafe a place here.
Many phyficians have confidered it as an
object of practice, and as giving, even in
no very high degree, a difpofition to many
difeafes ; I am of opinion that it fhould be
an object of practice more frequently than
it has been, and therefore that it merits
our confideraticm here.
MDCXXII.
It may perhaps be alleged, that I have
not been fufficiently correct, in putting
the difeafe of corpulency as an intume-
P 2 fcentia
32o PRACTICE
fcentia pinguedinofa, and therefore im-
plying its being an increafe of the bulk of
the body from an accumulation of oil in
the cellular texture only. I am aware of
this objection : and as I have already faid,
that emaciation (MDCII.) depends ei-
ther upon a general deficiency of fluids in
the vafcular fyftem, or upon a deficiency
of oil in the cellular texture ; fo I mould
perhaps have obferved farther, that the
corpulency, or general fulnefs of the body,
may depend upon the fulnefs of the vaf-
cular fyftem as well as upon that of the
cellular texture. This is true ; and for
the fame reafons I ought, perhaps, after
Linnaeus and Sagar, to have fet down ple-
thora as a particular difeafe, and as an in-
ftance of morbid intumefcence. I have,
however, avoided this, as Sauvages and
Vogel have done ; becaufe I apprehend
that plethora is to be confidered as a
flate of temperament only, which may
indeed difpofe to difeafe ; but not as a
dif-
OF PHYSIC. 221
difeafe in itfelf, unlcfs, in the language
of the Stahlians, it be a plethora com-
mota, when it produces a difeafe accom-
panied with particular fymptoms, which
give occafion to its being diflinguifhcd
by a different appellation. Further, it
appears to me, that the fymptoms which
Linnxus, and more particularly thofe
which Sagar employs in the character of
plethora, never do occur but when the
intumefcentia pinguedinofa has a great
mare in producing them. It is, however,
very neceffary to obferve here, that ple-
thora and obefity are generally combined
together ; and that in fome cafes of cor-
pulency it may be difficult to determine
which of the caufes has the greateft (hare
in producing it. It is indeed very poffible
that a plethora may occur without great:
obefity; but I apprehend that obefity never
happens to a confiderable degree without
producing a plethora ad fpatium in a great
P 3 part
J
222
PRACTICE
part of the fyftem of the aorta, and there-
fore a plethora ad mokm in the lungs, and
in the veflels of the brain.
MDCXXIIT.
In attempting the cure of polyfarcia, I
am of opinion that the conjunction of
plethora and obefity, in the manner juft
now mentioned, fliould be conftantly at-
tended to ; and when the morbid effects
of the plethoric habit are threatened, either
in the head or lungs, that blood-letting is
to be pradtifed : but at the fame time it is
to be obferved, that perfons of much obe-
fity do not bear blood-letting well ; and
when the circumftances 1 have mentioned
do not immediately require it, the prac-
tice upon account of obefity alone, is
hardly ever to be employed. The fame
remark is to be made with refpect to any
other evacuations that may be propofed
for
OF PHYSIC. 223
for the cure of corpulency : for without
the other means I am to mention, they can
give but a very imperfeft relief; and, in
fo far as they either empty or weaken the
fyftem, they may favour the return of ple-
thora, and the increafe of obefity.
MDCXXIV.
Polyfarcia, or corpulency, whether it
depend upon plethora or obefity, when-
ever it either can be confidered as a dif-
eafe, or threatens to induce one, is to be
cured, or the effedls of it are to be obvia-
ted, by diet and exercife. The diet muft
be fparing ; or rather, what is more ad-
miflible, it muft be fuch as affords little
nutritious matter. It mult therefore be
chiefly, or almoft only, of vegetable mat-
ter, and at the very utmoft of milk. Such
a diet mould be employed, and generally
ought to precede exercife : for obefity does
P 4 not
224 PRACTICE
not eafily admit of bodily exercife; which
is, however, the only mode that can be
very effectual. Such, indeed, in many
cafes, may feem difficult to be admitted ;
but I am of opinion, that even the mod
corpulent may be brought to bear it, by
at firft attempting it very moderately, and
increafing it by degrees very flowly, but
at the fame time perfifling in fuch attempts
with great conflancy.
MDCXXV.
As thefe, though the only effe&ual mea*-
fures, are often difficult to be admitted or
carried into execution, fome other means
have been thought of and employed for
reducing corpulency. Thefe, if 1 miftake
not, have all been certain methods of in-
ducing a faline ftate in the mafs of blood ;
for fuch I fuppofe to be the effecls of vi-
negar and of foap, which have been prc-
pofed.
OF PHYSIC.
pofed. The latter, T believe, hardly paffes
into the blood- veffels, without being refol-
ved and formed into a neutral fait, with
the acid which it meets with in the fto-
mach. How well acrid and faline fub-
ftances are fitted to diminifh obefity, may
appear from what has been faid above in
MDCXV. What effects vinegar, ibap,7* or $:/h^^jtif
other fubftances employed, have had in o/^ rzz &***
reducing corpulency, there have not pro- fJ *-'j£j£.
per opportunities of obferving occurred
to me : but I am well perfuaded, that the
inducing a faline and acrid ftate of the
blood, may have worfe confequences than
the corpulency it was intended to correct;
and that no perfon fhould hazard thefe,
while he may have recourfe to the more
fafe and certain means of abftinence and
fxercife.
CHAP,
226
PRACTICE
CHAP.
II.
Of Flatulent Swellings.
MDCXXVI.
THE cellular texture of the human bo-
dy very readily admits of air, and al-
lows the fame to pafs from any one to eve-
ry other part of it. Hence Emphyfemata
have often appeared from air colleded in
the cellular texture under the fkin, and in
feveral other parts of the body. The fla-
tulent fwellings under the fkin, have in-
deed mod commonly appeared in confe-
quence
OF PHYSIC, 227
quenceof air imnu\li;u ' ioducedfrom
without: hut in ces of flatulent
fvvellings, ef ... fc of the internal
parts nor communicating with the alimen-
tary canal, fuch an introduction cannot be
perceived or fuppofed; and therefore, in
thefe cafes, fome other caufe of the pro-
duction and collection of air muft be look-
ed for, though it is often not to be clearly
afcertained.
In every folid as well as every fluid fub-
ftance which makes a part of the human
body, there is a confiderable quantity of
air in a fixed (late, which may be again re-
ftored to its elaftic ftate, and feparated from
thofe fubftances, by the power of heat, pu-
trefaction, and perhaps other caufes : but
which of thefe may have produced the fe-
veral inftances of pneumatofis and flatu-
lent fwellings that have been recorded by
authors, I cannot pretend to afcertain.
Indeed, upon account of thefe difficulties,
I
22S PRACTICE
I cannot proceed with any clearnefs on the
general fubject of pneumatofis ; and, there-
fore, with regard to flatulent fwellings, I
find it necefiary to confine myfelf to the
confideration of thofe of the abdominal
region alone ; which I fliall now treat
of under the general name of Tympa-
nites.
MDCXXVIL
The tympanites is a fwelling of the ab-
domen ; in which the teguments appear to
be much ftretched by fome diftending
power writhin, and equally ftretched in
every pofture of the body. The fwelling
does not readily yield to any prefTure;
and in fo far as it does, very quickly re-
covers its former ftate upon the prefTure
being removed. Being (truck, it gives a
found like a drum, or other ftretched ani-
mal membranes. No fluctuation within
O F PHYSIC. 2:
is to be perceived: and the whole feels lef<i
weighty than might be expected from its
bulk. The uneafineis of the diftention is
commonly relieved by the difcharge of air
from the alimentary canal, either upwards
or downwards.
MDCXXVIII.
Thefe are the chara&ers by which the
tympanites may be diftinguifhed from the
a 1 cites or phyfconia ; and many experi-
ments mow, that the tympanites always
depends upon a preternatural collection of
air, fomewhere within 'the teguments of
the abdomen : but the feat of the air is in
different cafes fomewhat different ; and
this produces the different fpecies of the
difeafe.
One fpecies is, when the air collected is
entirely confined within the cavity of the
alimentary canal, and chiefly in that of the
inteftines,
23o PRACTICE
inteftines. This fpecies, therefore, is named
the Tympanites intejlinalis, Sauv. fp. i. It
is, of all others, the mod common; and to
it efpecially belong the chara&ers given a-
bove.
A fecond fpecies is, when the air collec-
ted is not entirely confined to the cavity of
the inteftines, but is alfo prefent between
their coats; and fuch is that which is na-
med by Sauvages Tympanites enteropbyfodes,
Sauv. fp. 3. This has certainly been a
rare occurrence; and has probably occur-
red only in confequence of the tympanites
intejlinalis^ by the air efcaping from the
cavity of the inteftines into the interfaces
of the coats. It is, however, poffible that
an erofion of the internal coat of the inte-
ftines may give occafion to the air, fo con-
ftantly prefent in their cavity, to efcape
into the interftices of their coats, though
in the whole of their cavity there has been
no previous accumulation.
1 A
O F P H Y S I C. aji
A third fpecies is, when the air is col-
lected in the fac of the peritonaeum, or
what is commonly called the cavity ot the
abdomen, that is, the f'pace between the
peritonaeum and vifcera; and then the dif-
eafe is named Tympanites abJominalisy Sauv.
fp. 2. The exigence of fuch a tympanites,
without any tympanites intejlinalis, has been
difputed; and it certainly has been a rare
occurrence : but from feveral diflfcclions, it
is unqueftionabie that fuch a difeafe has
fometimes truly occurred.
A fourth fpecies of tympanites is, when
the tympanites intejlinalis and abdominalis
are joined together, or take place at the
fame time. With refpedt to this, it is
probable that the tympanites intejlinalis is
the primary difeafe; and the other, only
a confequence of the air efcaping, by an
erofion or rupture of the coats of the in-
teftines, from the cavity of thefe into that
of the abdomen. It is indeed poflible, that
in
j32 PRACTICE
in confequence of erofion or rupture, the
air which is fo conftantly prefent in the
inteftinal canal, may efcape from thence
in fuch quantity into the cavity of the ab-
domen, as to give a tympanites abdominalis^
whilft there was no previous confiderable
accumulation of air in the inteftinal cavity
itfelf ; but I have not fads to afcertain this
matter properly.
A fifth fpecies has alfo been enumerated.
It is when a tympanites abdominalis happens
to be joined with the hydrops af cites; and
fuch a difeafe therefore is named by Sau-
vages Tympanites afciticusy Sauv. fp. 4. In
mod cafes of tympanites, indeed, fome
quantity of ferum has, upon diffedtion,
been found in the fac of the peritonaeum ;
but that is not enough to conftitute the
fpecies now mentioned'; and when the col-
lection of ferum is more confiderable, it is
commonly where, both from the caufes
which have preceded, and likewife from
4 the
OF PHYSIC. ;33
the fymptoms which attend, the afcites
may be considered as the primary difeafe ;
and therefore that this combination does
not exhibit a proper fpecies of the tympa-
nites.
MDCXXIX,
As this lafl: is not a proper fpecies, and
as fome of the others are not only extremely
rare, but even, when occurring, are neither
primary, nor to be eafily diftinguifhed,
nor, as confidered in themfelves, admitting
of any cure, I fhall here take no further
notice of them; confining myfelf, in what
follows, to the confideration of the mod
frequent cafe, and almoft the only object
of practice, the tympanites intejlinalis.
MDCXXX.
With refpect to this, I cannot perceive
Vol. IV. Q^ that
234 PRACTICE
that it arifes in any peculiar temperament,
or depends upon any predifpofition, which
can be difcerned. It occurs in either fex,
at every age, and frequently in young per-
fons.
MDCXXXI.
Various remote caufes of it have been
afligned: but many of thefehave not com-
monly the effedt of producing this difeafe;
and although fome of them have been
truly antecedents of it, I can in few in-
flances difcover the manner' in which they
produce the difeafe, and therefore cannot
certainly afcertain them to have been cau-
fes of it.
MDCXXXII.
The phenomena of this difeafe in its fe-
veral ftages are the following.
The
OF PHYSIC. 235
The tumour ot the belly fomctimes
grows very quickly to a confiderable de-
gree, and feldom in the flow manner the
nfcites commonly comes on. In ibme ca-
fe?, however, the tympanites comes on gra-
dually, and is introduced by an unufual
flatulency of the ftomach and inteftines,
with frequent borborygmi, and an uncom-
monly frequent expullion of air upwards
and downwards. This ftate is alfo fre-
quently attended with colic pains, efpe-
cially felt about the navel, and upon the
fides towards the back ; but generally as
the difeafe advances, thefe pains become
lefs confiderable. As the difeafe advances,
there is a pretty conftant defire to dif-
charge air,but it is accomplished with dif-
ficulty : and when obtained, although it
gives fome relief from the fenk of deten-
tion, this relief is commonly tranfient and
of ihort duration. While the difeafe is co-
ming on, fome inequality of tumour and
Qjz tenfion
2j6 PRACTICE
tendon may be perceived in different parts
of the belly ; but the didention foon be-
comes equal over the whole, and exhibits-
the phenomena mentioned in the charac-
ter. Upon the fird comming on of the
difeafe, as well as during its progrefs, the
belly is bound, and the fxces difcharged
are commonly hard and dry. The urine,
at the beginning, is ufually very little
changed in quantity or quality from its
natural ftate : but as the difeafe conti-
nues, it is commonly changed in both re-
fpe&s ; and at length fometimes a dran-
gury, and even an ifchuria, comes on.
The difeafe has feldom advanced far, be-
fore the appetite is much impaired, and
digeftion ill performed; and the whole
body, except the belly, becomes confi-
derably emaciated. Together with thefe
fymptomsy a third and uneafy fenfe of
heat at length comes on, and a confider-
able frequency of pulfe occurs, which con-
tinues
O F P II Y S I C. 237
tinues throughout the courfe of the dif-
eafc. When the tumour of the belly ari-
fes to a confiderable bulk, the breathing
becomes very difficult, with a frequent
dry cough. With all thefe fymptoms the
ltrength of the patient declines ; and the
febrile fymptoms daily increafing, death
at length enfues, fometimes probably in
confequence of a gangrene coming upon
the inteftines.
MDCXXXIIL
The tympanites is commonly of fome
duration, and to be reckoned a chronic
difeafe. It is very feldom quickly fatal,
except where fuch an affection fuddenly
arifes in fevers. To this Sauvages has
properly given a different appellation, that
of Meteorifmus ; and I judge it may always
be confidered as a fymptomatic affection,
Q^ 3 en-
238 P R A C T I C L
entirely diftindl from the tympanites we
are now confidering.
MDCXXX1V.
The tympanites is generally a fatal dif-
eafe, feldom admitting of cure; but what
may be attempted in this way, I fhall try
to point out, after I (hail have endeavoured
to explain the proximate caufe, which a-
lone can lay the foundation of what may
be rationally attempted towards its cure.
MDCXXXV.
To afcertain the proximate caufe of
tympanites, is fomewhat difficult. It has
been fuppofed in many cafes, to be merely
an uncommon quantity of air prefent in
the alimentary canal, owing to the extri-
cation and detachment of a greater quan-
tity
v
OF P H Y S I C. 239
tity of air than ufual from the alimentary
matters taken in. Our vegetable aliments, I
believe, always undergo ibme degree of fer-
mentation ; and in confequence, a quan-
tity of air is extricated and detached from
them in the ftomach and interlines : but it
appears, that the mixture of the animal
fluids which our aliments meet with in
the alimentary canal, prevents the fame
quantity of air from being detached from
them that would have been in their fer-
mentation without fuch mixture ; and it is
probable that the fame mixture contri-
butes alfo to the reabforption of the air
that had been before in fome meafure de-
tached. The extrication, therefore, of an
unufual quantity of air from the aliments,
may, in certain circumftances, be fuch,
perhaps, as to produce a tympanites; io
that this difeafe may depend upon a fault
of the digeflive fluids, whereby they are
unfit to prevent the too copious extrica-
0^4 tio:1
i+o PRACTICE
tion of air, and unfit: alfb to occafion that
reabforption of air which in found per-
fons commonly happens. An unufual
quantity of air in the alimentary canal,
whether owing to the nature of the ali-
ments taken in, or to the fault of the di-
geftive fluid, does certainly fometimes take
place ; and may poffibly have, and in
fome meafure certainly has, a fhare in
producing certain flatulent diforders of the
alimentary canal ; but cannot be fuppofed
to produce the tympanites, which often
occurs when no previous diforder had ap-
peared in the fyftem. Even in thofe cafes
of tympanites which are attended at their
beginning with flatulent diforders in the
whole of the alimentary canal, as we know
that a firm tone of the inteflines both mo-
derates the extrication of air, and contri-
butes to its reabforption or ready expul-
fion, fo the flatulent fympcoms which hap-
pen to appear at the coming on of a
tym-
O F P II Y S I C. 241
tympanites, arc, in my opinion, to be re-
ferred to a lofi of tone in the mufcular
fibres of the inteftines, rather than to any
fault in the digeftive iluids.
MDCXXXVI.
Thefc, and other confiderations, lead
me to conclude, chat the chief part of the
proximate caufe of tympanites, is a lofs of
tone in the mufcular fibres of the inte-
ftines. But further, as air of any kind
accumulated in the cavity of the inteftines
ihould, even by its own elaflicity, find its
way either upwards or downwards, and
fhould alfo, by the afliftance of infpira-
tion, be entirely thrown out of the body ;
fo, when neither the reabforption nor the
expuliion takes place, and the air is accu-
mulated fo as to produce tympanites, it is
probable that the paflage of the air along
the courfc of the inteftines is in fome
places
k
242
PRACTICE
places of thefe interrupted. This inter-
ruption, however, can hardly be fuppofed
to proceed from any other caufe than fpaf-
modic conftridtions in certain parts of the
canal ; and I conclude, therefore, that fuch
conftridtions concur as part in the proxi-
mate caufe of tympanites. Whether thefe
fpafmodic conftridtions are to be attribu-
ted to the remote caufe of the difeafe, or
may be confidered as the confequence of
fome degree of atony firft arifing, I cannot
with certainty, and do not find it neceffary
to determine.
MDCXXXVII.
Having thus endeavoured to afcertaii
the proximate caufe of tympanites, I pro-
ceed to treat of its cure ; which indee<
has feldom fucceeded, and almoft nevei
but in a recent difeafe. 1 muft, however,
endeavour to fay what may be reafonabl;
3 at"
OF PHYSIC. 243
attempted ; what has commonly been at-
tempted ; and what attempts have fome-
tim:s fucceeded in the cure of this dif-
safe.
MDCXXXV1II.
It mud be a firft indication to evacuate
the air accumulated in the inteftines: and
for this purpofe it is neceflary that thofe
conftriclions, which had efpecially occa-
fioned its accumulation, and continue to
interrupt its paflage along the courfe of the
inteftines, mould be removed. As thefe,
however, can hardly be removed but by
exciting the periftaltic motion in the ad-
joining portions of the inteftines, purgatives
have been commonly employed; but it is at
the fame time agreed, that the more gentle
laxatives only ought to be employed, as
the more draftic, in the overftretched and
tenfe
244 PRACTICE
tenfe ftate of the inteftines, are in danger
of bringing on inflammation.
It is for this reafon, alfo, that glyfters
have been frequently employed ; and they
are the more neceflary, as the feces col-
lected are generally found to be in a hard
and dry ftate. Not only upon account of
this ftate of the faeces, but, farther, when
glyfters produce a confiderable evacuation
of air, and thus fhow that they have fome
eflfed in relaxing the fpafms of the inte-
ftines, they ought to be repeated very fre-
quently.
MDCXXXIX.
In order to take off the conftri&ions
of the inteftines, and with fome view alfo
to the carminative effedls of the medicines,
y jl, c»~-*+-j^ J ■■„ .various antifpafmodics have been propo-
*/ fed, and commonly employed ; but their
efFeds are feldom confiderable, and it is
2 alleged
OF PHYSIC. 245
alleged that their heating and inflamma-
tory powers have ibmetimes been hurtful.
It is, however, always proper to join fome
of the milder kinds with both the purga-
tives and glyfters that are employed ; and
it has been very properly advifed to give
always the chief of antif pafinodics, that is,
an opiate, after the operation of purgatives
is finifhed.
MDCXL.
In confideration of the overflretched,
tenfe, and dry ftate of the inteftines, and
efpecially of the fpafmodic conftridtions
that prevail, fomentations and warm ba-
thing have been propofed as a remedy; and
are faicj to have been employed with ad-
vantage : but it has been remarked, that
very warm baths have not been found fo
fcfefal as tepid baths long continued.
MDCXLI.
246 PRACTICE
MDCXLI.
Upon the fuppofition that this difeafe
depends efpecially upon an atony of the
alimentary canal, tonic remedies feem to
be properly indicated. Accordingly cha-
lybeates, and various bitters, have been em-
ployed ; and, if any atonic, the Peruvian
bark might probably be ufeful.
MDCXLII.
But as no tonic remedy is more power-
ful than cold applied to the furface of the
body, and cold drink thrown into the fto-
mach; fo fuch a remedy has been thought
of in this difeafe. Cold drink has been
conftantly prefcribed, and cold bathing
has been employed with advantage ; and
there have been feveral inftances of the dif-
eafe being fuddenly and entirely cured by
the
O F P H Y S I C. 247
the repeated application of fnow to the
lower belly.
MDCXLIIL
It is hardly neceffary to remark, that, in
the diet of tympanitic perfons, all forts of
food ready to become flatulent in the fto-
mach are to be avoided ; and it is probable,
that the foiTil acids and neutral falts, as
antizymics, may be ufeful.
MDCXL1V.
In obftinate and defperate cafes of tym-
panites, the operation of the paracentetic /, .^^ A^
has been propofed : but it is a very doubt- *KMM*e
ful remedy, and there is hardly any tefti-
mony of its having been pradlifed with
fuccefs. It mud be obvious, that this ope-
ration is a remedy fuited efpecially, and al-
mo(t only, to the tympanites abdominalis ; the
exiftence
248
PRACTICE
exiftence of which, feparately from the in-
tejlinalis, is very doubtful, at leaft not eafi-
ly afcertained. Even if its exiftence could
be afcertained, yet it is not very likely to
be cured by this remedy : and how far the
operation might be fafe in the tympanites
inteftinales, is not yet determined by any
proper experience*
CHAP.
OF PHYSIC. 249
CHAP. III.
Of Watery Swellings, or Dropsies.
A
MDCXLV.
Preternatural collection of fe- Jl+~~ - /~^~
rous or watery fluids, is often form— t. ^ulsz^L* v-
ed in different parts of the human body -9^1
and although the difeafe thence arifing be^>^y ^ <£-
diftinguifhed according to the different^ u/a#u^+z>
parts which it occupies, yet the whole of ^7 ^^ 9^^^'J-
fuch collections come under the general ^ ^u^S^L^l
Vol. IV. R ap-* ^/— -^.
25o PRACTICE
appellation of Dropfies. At the fame time,
altho* the particular inftances of fuch col-
lection are to be diftinguifhed from each
other according to the parts they occupy,
as well as by other circumftances attending
them ; yet all of them feem to depend up-
on fome general caufes, very much in
common to the whole. Before proceeding,
therefore, to confider the feveral fpecies, it
may be proper to endeavour to affign the
general caufes of dropfy.
MDCXLVI.
In perfons in health, a ferous or watery
fluid feems to be conftantly poured out, or
exhaled in vapour, into every cavity and
interftice of the human body capable of
receiving it ; and the fame fluid, without
remaining long or being accumulated in
thefe fpaces, feems conftantly to be foon
again abforbed from thence by veffels ad-
apted
OF PHYSIC. 251
apted to the purpofe. From this view of
the animal oxonomy, it will be obvious^
t;hat if the quantity poured out into any
fpace, happens to be greater than the ab-
forbents can at the lame time take up, an
unufual accumulation of ferous fluid will
be made in fuch parts j or though the
quantity poured out be not more than u-
fual, yet if the abforption be anywiie in-
terrupted or diminifhed, from this caufe
alfo an unufual collection of fluids may be
occafioned.
Thus, in general, dropfy may be imputed
to an increafed effufion, or to a diminished
abforption; and I therefore proceed to in*-
quire into the feveral caufes of thefe.
MDCXLVII.
An increafed effufion may happen, ei-
ther from a preternatural increafe of the
R 2 ordi-
252 PRACTICE
ordinary exhalation, or from the rupture
of vefTels carrying, or of facs containing,
ferous or watery fluids.
MDCXLVIII.
The ordinary exhalation may be increa-
fed by various caufes, and particularly by
an interruption given to the free return of
the venous blood from the extreme vefTels
of the body to the right ventricle of the
heart. This interruption feems to operate
by refifling the free pafTage of the blood
from the arteries into the veins, thereby
increafing the force of the arterial fluids in
the exhalants, and confequently the quan-
tity of fluid which they pour out.
MDCXLIX.
The interruption of the free return of
the venous blood from the extreme vefTels,
may
OF PHYSIC.
may be owing to certain circumllances af-
fecting the courfe of the venous blood ;
very frequently, to certain conditions in
the right ventricle of the heart itfelf, pre-
venting it from receiving the ufual quan-
tity of blood from the vena cava; or to
obftru&ions in the veflels of the lungs pre-
venting the entire evacuation of the right
ventricle, and thereby hindering its recei-
ving the ufual quantity of blood from the
cava. Thus, a polypus in the right ven-
tricle of the heart, and the oflification of
its valves, as well as all confiderable and
permanent obftrucftions of the lungs, have
been found'to be caufes of dropfy.
MDCL.
It may ferve as an illuftration of the
operation of thefe general caufes, to re-
mark, that the return of the venous blood
is in fome meafure refilled when the po-
ll 3 fture
254 PRACTICE
fture of the body is fuch as gives occafion
to the gravity of the blood to oppofe the
motion of it in the veins, which takes effeft
when the force of the circulation is weak j
and from whence it is that an upright po-
fture of the body produces or increafes fe-
rous fwellings in the lower extremities.
MDCLI.
Not only thofe caufes interrupting the
(rxY . motion of the venous blood more general-
/C^,^_ ly, but, farther, the interruption of it in
/J^^A ^tti^-f- particular veins, may likewife have the ef-
^/^- j/J^^-fe(5l of increafing exhalation, and produ-
Jv± ^u^u^ sfcttn^ cmg dropfy. The mod remarkable in-
.*" * s . fiance of this is, when conliderable ob-
A*^ _^ ftruftions of the liver prevent the blood
fu&./r£t^, from flowing freely into it from the vena
portarum and its numerous branches; and
hence thefe obftru&ions are a frequent
caufe of drop fy,
MDCL1I.
7.4>f.
O F PHYSI C. tSs
iMDCLII.
Scirrhofities of the fpleeu and other vii-
cera, as well as the fcirrhofity of the liver,
have been confidered as caufes of dropfy ;
but the manner in which they can pro-
duce the difeafe, I do not perceive, except
it may be where they happen to be near
fome confiderable vein, by the compref-
fion of which they may occafion fome de-
gree of afcites ; or, by comprefhng the ve-
na cava, may produce an anafarca of the
lower extremities. It is indeed true, that
fcirrhofuies of the fpleen and other vif-
cera, have been frequently difcovered in
the bodies of hydropic perfons : but I be-
lieve they have been feldom found unlefs
when fcirrhofuies of the liver were alfo
prefent ; and I am inclined to think, that
the former have been the effedls of the lat-
ter, rather than the caufe of the dropfy ;
Pv 4 or
256 PRACTICE
or that, if fcirrhofities of the other vifccra
have appeared in hydropic bodies when
that of the liver was not prefent, they muft
have been the effects of fome of thofe cau-
fes of dropfy to be hereafter mentioned ;
and confequently to be the accidental at-
tendants, rather than the caufes, of fuch
dropfies.
MDCLIII.
Even in fmaller portions of the venous
fyftem, the interruption of the motion of
the blood in particular veins has had the
fame effedt. Thus, a polypus formed in
the cavity of a vein, or tumours formed in
its coats, preventing the free paflage of the
blood through it, have had the effed: of
producing dropfy in pans towards the ex-
tremity of fuch veins.
MDCLIV:
O F P II Y S I G -r/
MDCLIV.
But the caufe mod frequently interrupt-*
ing the motion of the blood through the
veins is, the com predion of tumours exift-
aear to them; iuch as aneurifms in the
arteries, abfeefles, and fcirrhous or fteato-
matous tumours in the adjoining parts.
To this head may be referred the corn-
preffion of the defcending cava by the
bulk of the uterus in pregnant women,
and the compreflion of the fame by the
bulk of water in the afcites ; both of which
compreflions frequently produce ferous
fwellings in the lower extremities.
MDCLV.
It may be fuppofed, that a general pre-
ternatural plethora of the venous fyftem
may have the effect of increafing exhala-
tion ; and that this plethora may happen
from
258 PRACTICE
from the fuppreflion of fluxes, or evacua-
tions of blood, which had for fome time
taken place in the body, fuch as the men-
ftrual and hemorrhoidal fluxes. A dropfy,
however, from fuch a caufe, has been at
leaft a rare occurrence; and when it feems
to have happened, I fliould fuppofe it ow-
ing to the fame caufes as. the fuppreflion
itfelf, rather than to the plethora produ-
ced by it.
MDCLVI.
One of the mod frequent caufes of an
increafed exhalation, I apprehend to be the
laxity of the exhalani veflels. That fuch a
caufe may operate, appears probable from
this, that paralytic limbs, in which fuch a
laxity is to be fufpedled, are frequently af-
feded with ferous, or, as they are called,
cedematous fwellings.
But a much more remarkable and fre-
quent
OF PHYSIC. 259
quent example of its operation occurs in the
cafe of a general debility of the fyftem,
which is fo often attended with dropfy.
That a general debility does induce drop-
fy, appears fufliciently from its being fo
commonly the confequence of powerfully
debilitating caufes ; fuch as fevers, cither
of the continued or intermittent kind,
which have lafted long ; long -continued
and fomewhat exceffive evacuations of any
kinds ; and in fliort, almoft all difeafes
that have been of long continuance, and
have at the fame time induced the other
fymptoms of a general debility.
Among other caufes inducing a general
debility of the fyftem, and thereby drop-
fy, there is one to be mentioned as fre-
quently occurring, and that is, intempe-
rance in the ufe of intoxicating liquors ;
from whence it is that drunkards of all
kinds, and efpecially dram-drinkers, arc
fo affedted with this difeafe.
MDCLVH.
Co PRACTICE
MDCLV1L
That a general debility may produce a
laxity of the exhalants, will be readily al-
lowed ; and that by this efpecially it oo
cafions dropfy, I judge from thence, that
while mod of thecaufes already mentioned
are fuited to produce dropfies of particular
parts only, rhe ftate of general debility
gives rife to an increafed exhalation into
every cavity and interface of the body,
and therefore brings on a general dif-
eafe. Thus, we have feen effufions of a .
ferous fluid made, at the fame time, into
the cavity of the cranium, into that of the
thorax and of the abdomen, and like-
wife into the cellular texture almoft over
the whole of the body. In fuch cafes,
the operation of a general caufe difcover-
ed itfelf, by thefe feveral dropfies increa-
fing in one part as they diminfhied in an-
other, and this alternately in the different
parts.
O F P H Y S I C. 261
parts. This combination, therefore, of the
different fpecies of dropfy, or rather, as it
may be termed, this univerfal dropfy,
mud, I think, be referred to a genera!
caufe; and in mod inftances, hardly any
other can be thought of, but a general laxi-
ty of the exhalants. It is this, therefore,
that I call the hydropic dlathefis ; which fre-
quently operates by itfelf; and frequently,
in fome meafure, concurring with other
caufes, is efpecially that which gives them
their full effecl.
This ftate of the fyftem, in its firft ap-
pearance, feems to be what has been con-
fidered as a particular difeafe under the
name of Cachexy ; but in every inftance of
it that has occurred to me, I have always
confidered, and have always found, ic to
be the beginning of general dropfy.
MDCLVITI.
zGt PRACTICE
MDCLVIII.
The feveral caufes of dropfy already
mentioned may produce the difeafe, al-
though there be no preternatural abun-
dance of ferous or watery fluid in the
blood- vefTels; but it is now to be remark-
ed, that a preternatural abundance of that
kind may often give occaiion to the difeafe,
and more efpecially when fuch abundance
concurs with the caufes above enumera-
ted.
One caufe of fuch preternatural abun-
dance may be an unufual quantity of
water taken into the body. Thus an
unufual quantity of water taken in by
drinking, has fometimes occafioned a
dropfy. Large quantities of water, it
is true, are upon many occafions taken in;
and being as readily thrown out again
by (tool, urrne, or perfpiration, have not
produced any difeafe. But it is alfo cer-
tain,
OF PHYSIC. 263
tain, that, upon fome occafions, an unu-
fual quantity of watery liquors taken in
has run off by the feveral internal exha-
lants, and produced a dropfy. This feems
to have happened, either from the excre-
tories not being fitted to throw out the
fluid fo faft as it had been taken in, or
from the excretories having been obftrud-
ed by accidentally concurring caufes. Ac-
cordingly it is faid, that the fudden taking
in of a large quantity of very cold water,
has produced dropfy, probably from the
cold producing a conftridion of the ex-
cretories.
The proportion of watery fluid in the
blood may be increafed, not only by the
taking in a large quantity of water by
drinking, as now mentioned, but it is
poflible that it may be increafed alfo by
water taken in from the atmofphere by
the fkin in an abforbing or imbibing
ftate. It is well known that the fkin may
1 be,
&84 PRACTICE
be, at leaft, occafionally in fuch a Rate ;
and it is probable, that in many cafes of
beginning dropfy, when the circulation of
the blood on the furface of the body is very
languid, that the fkin may be changed
from a perfpiring to an imbibing ftate ;
and thus, at leaft, the difeafe may be very
much increafed.
MDCLIX.
A fecond caufe of a preternatural abun-
dance of watery fluids in the blood-vef-
fels, may be, an interruption of the or-
dinary watery excretions; and according-
ly it is alleged, that perfons much expo-
fed to a cold and moift air are liable to
dropfy. It is alfo faid, that an interrup-
tion, or confiderable diminution, of the
urinary fecretion, has produced the dif-
eafe : and it is certain, that, in the cafe of
an ifchuria renalis, the ferofity retained in
the blood-veffels has been poured out into
4 fome
OF PHYSIC. 265
fome internal cavities, and has occafioned
dropfy.
MDCLX.
A third caufe, of an over-proportion of
ferous fluid in the blood ready to run off
by the exhalants, has been very large eva-
cuations of blood, either fpontaneous or
artificial. Thefe evacuations, by abftrac-
ting a large proportion of red globules
and gluten, which are the principal means
of retaining ferum in the red vefTels, al-
low the ferum to run off more readily by
the exhalants : and hence dropfies have
been frequently the confequence of fuch
evacuations.
It is poffible alfo, that large and long-
continued iffues, by abftracfting a large
proportion of gluten, may have the fame
effed.
An over- proportion of the ferous parts
Vol. IV. S of
266 PRACTICE
of the blood, may not only be owing to
the /pollution juft now mentioned, but
may, I apprehend, be likewife owing to a
fault in the digefting and affimilating
powers in the ftomach and other organs ;
whereby they do not prepare and convert
the aliments taken in, in fuch a manner
as to produce from them the due propor-
tion of red globules and gluten ; but, ftill
continuing to fupply the watery parts, oc-
cafion thefe to be in an over- proportion,
and confequently ready to run off in too
large quantity by the exhalants. It is in
this manner that we explain the dropfy, fo
often attending chlorofis : which appears
always at firft by a pale colour of the whole
body, fhowing a manifeft deficiency of red
blood ; which in that difeafe can only be
attributed to an imperfect digeftion and
affimilation.
Whether a like imperfedlion takes place
in what has been called a Cachexy \ I dare
not
L.
OF PHYSIC, 267
not determine. This difeafe indeed has
been commonly and very evidently owing
to the general caufes of debility above
mentioned : and it being probable that the
general debility may affect the organs of
digeftion and aflimilation ; fo the imper-
fect ftate of thefe functions, occafioning a
deficiency of red globules and gluten, may
often concur with the laxity of the exha-
lants in producing dropfy.
MDCLXL
Thefe are the feveral caufes of increa-
fed exhalation, which I have mentioned as
the chief caufe of the effufion producing
dropfy ; but I have likewife obferved in
MDCXLY1L that with the fame effect, an
effufion may alfo be made by the rupture
of veffels carrying watery fluids.
In this way, a rupture of the thoracic
duct, has given occafion to an effufion of
S 2 chyle
*68 PRACTICE
chyle and lymph into the cavity of the
thorax ; and a rupture of the ladleals has
occafioned a like effufion into the cavity of
the abdomen ; and in either cafe, a dropfy
has been produced.
It is fufficiently probable, that a rupture
of lymphatics, in confequence of ftrains,
or the violent compreffion of neighbour-
ing mufcles, has occafioned an effufion ;
which, being difFufed in the cellular tex-
ture, has produced dropfy.
It belongs to this head of caufes, to re-
mark, that there are many inftances of a
rupture or erofion of the kidneys, ureters,
and bladder of urine ; whereby the urine
has been poured into the cavity of the ab-
domen, and produced an afcites.
MDCLXIL
Upon this fubjedl, of the rupture of
veffels carrying, or of veficles containing,
watery
<
O F P H Y S I C. 269
watery fluids, I mud obferve, that the
diffe&ion of dead bodies has often fhown
veficles formed upon the furface of many
of the internal parts ; and it has been fup-
pofed, that the rupture of fuch veficles,
commonly named Hydatides^ together with
their continuing to pour out a watery fluid,
has been frequently the caufe of dropfy,
I cannot deny the poflibility of fuch a
caufe, but fufpecft the matter muft be ex-
plained in a different manner.
There have been frequently found, in
almoft every different part of animal bo-
dies, collections of fpherical veficles, con-
taining a watery fluid ; and in many cafes
of fuppofed dropfy, particularly in thofe
called the preternatural encyfled dropfies,
the fwelling has been entirely owing to a
collection of fuch hydatides. Many con-
jectures have been formed with regard to
the nature and production of thefe vefi-
cles \ but the matter at laft feems to be
S 3 afcertained.
■
2jo PRACTICE
afcertalned. It feems to be certain, that
each of thefe veficles has within it, or an-
nexed to it, a living animal of the worm
kind ; which feems to have the power of
forming a veficle for the purpofe of its
own oeconomy, and of filling it with a
watery fluid drawn from the neighbour-
ing parts: and this animal has therefore
been properly named by late naturalifts,
the Tama hydatigena. The origin and
oeconomy of this animal, or an account
qf the feveral parts of the human body
which it occupies, I cannot profecute fur-
ther here; but it was proper for me, in
delivering the caufes of dropfy,to fay thus
much of hydatides : and I muft conclude
with obferving, I am well perfuaded, that
mod of the inftances of preternatural en-
cyfted dropfies which have appeared in
niany different parts of the human body,
have been truly collections of fuch hy-
datides ; but how the fwellings occafioned
by
OF PHYSIC. 271
by thefe are to be diftinguifhed from other
fpecies of dropfy, or how they are to be
treated in pra&ice, I cannot at prefent de-
termine.
MDCLXI1I.
After having mentioned thefe, I return
to confider the other general caufe of drop-
fy, which 1 have faid in MDCXLVI. may
be, An interruption or diminution of the
abforption that fhould take up the exha-
led fluids from the feveral cavities and in-
terfaces of the body ; the caufes of which
interruption, however, are not eafily af-
certained.
MDCLXIV.
It feems probable, that abforption maybe
diminifhed, and even ceafe altogether, from
a lofs of tone in the abforbent extremities
S 4 of
??l PRACTICE
of the lymphatics. I cannot indeed doubt
that a certain degree of tone or adtive
power is necefTary in thefe abforbent ex-
tremities; and it appears probable, that the
fame general debility which produces that
laxity of the exhalant veffels, wherein I have
fuppofed the hydropic diathefis to confift,
will at the fame time occafion a lofs of
tone in the abforben^s ; and therefore that
a laxity of the exhalants will generally be
accompanied with a lofs of tone in the ab-
forbents ; and that this will have a fhare
in the production of drppfy. Indeed it is
probable that the diminution of abforption
has a confiderable fhare in the matter ; as
dropfies are often cured by medicines which
feem to operate by exciting the a&ion of
the abforbents.
MDCLXV.
It has been fuppofed, that the abforption
per-
O F P II Y S I C. 273
performed by the extremities of lymphatics
may be interrupted by an obltrucYion of
thefe veffels, or at leaft of the conglobate
glands through which thefe veffels pafs.
This, however, is very doubtful. As the
lymphatics have branches frequently com-
municating with one another, it is not
probable that* the obftrudtion of any one,
or even feveral of thefe, can have any con-
iiderable effect in interrupting the abforp-
tion of their extremities.
And for the fame reafon, it is as little
probable that the obftru&ion of conglo^-
bate glands can have fuch an effect : at
lead it is only an obftru&ion of the glands
of the mefentery, through which fo con-
siderable a portion of the lymph paffes,
that can poflibly have the effect of inter*
ruptingabfprption. Buteven this wefhould
not readily fuppofe, there being reafon to
believe that thefe glands, even in a con-
fidently tumefied ftate, are not entirely
ob-
*74 PRACTICE
obftru&ed: And accordingly I have known
feveral inftances of the mod part of the
mefenteric glands being confiderably tu-
mefied, without either interrupting the
tranfmiflion of fluids to the blood-veflels,
or occafioning any dropfy.
An hydropic fwelling, indeed, feems of-
ten to affed the arm from a tumour of the
axillary gland : but it feems to me doubt-
ful, whether the tumour of the arm may
not be owing to fome compreffion of the
axillary vein, rather than to an obftru<5Hon
of the lymphatics,
MDCLXVI.
A particular interruption of abforption
may be fuppofed to take place in the brain.
As no lymphatic veflels have yet very
certainly been difcovered in that organ,
it may be thought that the abforption,
which certainly takes place there, is per-
formed
OF P II Y S I C. 275
formed by the extremities of veins, or by
veflels that carry the fluid directly into
the veins ; fo that any impediment to the
free motion of the blood in the veins of
the brain, may interrupt the abforption
there, and occafion that accumulation of
ferous fluid which fo frequently occurs
from a congeflion of blood in thefe veins.
But I give all this as a matter of conjecture
only.
MDCLXVII.
Having thus explained the general cau-
fes of dropfy, I fliould proceed, in the next
place, to mention the feveral parts of the
body in which ferous collections take place,
and fo to mark the different fpecies of
dropfy : but I do not think it neceffary for
me to enter into any minute detail upon
this fubject. In many cafes thefe collections
are not to be afcertained by any external
fymp-
276 PRACTICE
fymptoms, and therefore cannot be the ob-
jeifts of pradtice ; and many of them, tho'
in fome meafure difcernible, do not feem
to be curable by our art. I the more efpe-
cially avoid mentioning very particularly
the feveral fpecies, becaufe that has already
been fufficiently done by Dr D. Monro,
and other writers, in every body's hands.
I muft confine myfelf here to the confide-
ration of thofe fpecies which are the mod
frequently occurring and the moft com-
mon objects of our pra&ice; which are,
the Anafarca, Hydrothorax, and Afcites ;
and each of thefe I fhall treat in fo many
feparate fe&ions.
SECT,
O F P H Y S I C. 277
SECT.
Of Anasarca.
MDCLXVIIL
The Anafarca is a fwelling upon the
furface of the body, at firft commonly ap-
pearing in particular parts only, but at
length frequently appearing over the whole.
So far as it extends, it is an uniform fwel-
ling over the whole member, at firft always
foft, and readily receiving the preffure of
the finger, which forms a hollow that re-
mains for fome little time after the preflure
is
278 PRACTICE
removed, but at length rifes again to its
former fulnefs. This fwelling generally
appears, firft, upon the lower extremities;
and there too only in the evening, difap-
pearing again in the morning. It is ufual-
ly more confiderable as the perfon has
been more in an eredt pofture during the
day ; but there are many inftances of the
exercife of walking preventing altogether
its otherwife ufual coming on. Although
this fwelling appears at firft only upon the
feet and about the ankles ; yet if the cau-
fes producing it continue to ad, it gra-
dually extends upwards, occupying the
legs, thighs, and trunk, of the body, and
fometimes even the head. Commonly the
fwelling of the lower extremities dimi-
nifhes during the night; and in the morn-
ing, the fwelling of the face is moft confi-
derable, which again generally difappears
almoft entirely in the courfe of the day.
MDCLXIX.
O F P II Y S I C. 279
MDCLXIX.
The terms of Anafarca and Leucophleg-
matla have been commonly confidered as
fynonimous ; but fome authors have pro-
pofed to confider them as denoting di-
flincT: difeafes. The authors who are of
this lall opinion employ the name of Ana-
farca for that difeafe which begins in the
lower extremities, and is from thence gra-
dually extended upwards in the manner I
have juft now described ; while they term
Leucophlegmatia^ that in which the fame
kind of fwelling appears even at firft very
generally over the whole body. They feem
to think alfo, that the two difeafes proceed
from different caufes; and that, while the
anafarca may arife from the feveral caufes
in MDCXLV1II.— MDCL1X. the leuco-
phlegmatia proceeds efpecially from a de-
ficiency of red blood, as we have mention-
ed in MDCLX, etfeq. I cannot, however,
fad
1
280 PRACTICE
find any proper foundation for this di-
flindtion. For although in dropfies pro-
ceeding from the caufes mentioned in
MDCLX, et fcq. the difeafe appears in
fome cafes more immediately afFedling the
whole body ; yet that does not eftablifh a
difference f;om the common cafe of ana-
farca : for the difeafe, in all its circum-
ftances, comes at length to be entirely the
fame ; and in cafes occafioned by a defi-
ciency of red blood, I have frequently
obferved it to come on exadtly in the
manner of an anafarca, as above defcribed.
MDCLXX,
An anafarca is evidently a preternatural
colle&ion of ferous fluid in the cellular tex-
ture immediately under the ikim Some-
times pervading the fkin itfelf, it oozes out
through the pores of the cuticle; and
fometimes, too grofs to pafs by thefe, it
raifes the cuticle in blifters. Sometimes
i the
Of PHYSIC. nil
die (kin, not allowing the water to per-
vade ic, is comprefled and hardened, and
at the fame time fo much diftended, as to
give anafarcous tumours an unufual firm-
nefs. It is in thefe laft circumftances alfo
that an erythematic inflammation is ready-
to come upon anafarcous fwellings.
MDCLXXL
An anafarca may immediately arife from
any of the feveral caufes of dropfy which
acfl more generally upon the fyftem : and
even when other fpecies of dropfy, from
particular circumftances, appear firft; yet
whenever thefe proceed from any caufes
more generally affecting the fyftem, an
anafarca fooner or later comes always to be
joined with them.
Vol. IV. T MDCLXXII.
282 PRACTICE
MDCLXXII.
The manner in which chis difeafe com-
monly firft appears, will be readily ex-
plained by what I have faid in MDCL. re-
fpedling the effe&s of the pofture of the
body. Its gradual progrefs, and its affec-
ting, after fome time, not only the cellular
texture under the fkin, but probably alfo
much of the fame texture in the internal
parts, will be underftood partly from the
communication that is readily made be-
tween the feveral parts of the cellular tex-
ture ; but efpecially from the fame general
caufes of the difeafe producing their ef-
fedls in every part of the body. It appears
to me, that the water of anafarcous fwell-
ings is more readily communicated to the
cavity of the thorax, and to the lungs, than
to the cavity of the abdomen, or to the
yifcera contained in it.
MDCLXXIIL
O t PHYSIC. 283
MDCLXXIN
An anafarca is almoft always attended
with a fcarcicy of urine; and the urine
voided, is, from its fcarcity, always of a
high colour ; and from the fame caufe,
after cooling, readily lets fall a copious
reddifh fediment. This fcarcity of urine
may fometimes be owing to an obftrucUon
of the kidneys; but probably is generally
occafioned by the watery parts of the blood
running off into the cellular texture, and
being thereby prevented from palling in
the ufual quantity to the kidneys. **— ^J+zf+Au,
The difeafe is alfo generally attended^ u^^^u LI hk
with an unufual degree of third 5 a cir-~' ~£5L
cumftance I would attribute to a like ab-~' '~ w^
flradlion of fluid from the tongue and fau-/.^ ^^ u/^*^ «.
ces^Which are extremely fenfible to every7 - ^u'
diminution of the fluids in thefe parts. ±*~ O . ^ yj
T 2 MDCLXXlV.^w, . %Z.
284 PRACTICE
MDCLXXIV.
The cure of anfarca is to be attempted
upon three general indications.
i * The removing the remote caufes of
the difeafe.
2. The evacuation of the ferous fluid al-
ready collected in the cellular texture.
3. The reftoring the tone of the fyftem,
the lofs of which may be confidered in
many cafes as the proximate caufe of the
difeafe.
MDCLXXV.
The remote caufes are very often fuch
as had not only been applied, but had alfo
been removed, long before the difeafe
came on. Although, therefore, their effects
remain, the caufes themfelves cannot be the
objects of practice; but if the caufes ftill
continue to be applied, fuch as intempe-
rance,
J
O F P II Y S I C. 285
ranee, indolence, and fome others, they
muft be removed. For the moft part, the
remote caufes are certain difeafes previous
to the dropfy, which are to be cured by
the remedies particularly adapted to them,
and cannot be treated of here. The curing
of thefe, indeed, may be often difficult ; but
ic was proper to lay down the prefent in-
dication, in order to (how, that when thefe
remote caufes cannot be removed, the cure
of the dropfy muft be difficult, or perhaps
impoffible. In many cafes, therefore, the
following indications will be to little pur^
pofe; and particularly, that often the exe-
cution of the fecond will not only give the
patient a great deal of fruitlefs trouble, but
commonly alfo hurry on his fate.
MDCLXXVI.
The fecond indication for evacuating
the colle&ed ferum, may be fometimes
T x exe-
286 PRACTICE
executed with advantage, and often, at
leaft,with temporary relief. It may be per-
formed in two ways. Firfl:, by drawing off
the water directly from the dropfical part,
by openings made into it for thatpurpofe:
Or, fecondly, by exciting certain ferous
excretions; in confequence of which, an
abforption may be excited in the dropfical
parts, and thereby the ferum abforbed and
carried into the blood- veflels, may after-
wards be directed to run out, or may fpon-
taneoufly pafs out, by one or other of the
common excretions.
MDCLXXVIL
In an anafarca, the openings into the
dropfical part are commonly to be made
in fome part of the lower extremities; an4
will be mod properly made by many fmall
punctures reaching the cellular texture.
Formerly, confiderable incifions were em-
ployed
l
OF PHYSIC. 287
ployed for this purpofe: but as any wound
made in dropfical parts, which, in order
to their healing, muft neceflarily inflame
and fuppurate, are liable to become gan-
grenous ; fo it is found to be much fafer to
make the openings by fmall pundlures on-
ly, which may heal up by the firft inten-
tion. At the fame time, even with refpedl
to thefe pundures, it is proper to obferve,
that they mould be made at fome diftance
from one another, and that care fhould be
taken to avoid making them in the mod
depending parts.
MDCLXXVIII.
The water of anafarcous limbs may be
fometimes drawn off by pea-ifTues, made
by cauftic a little below the knees ; for as
the great fwelling of the lower extremities
is chiefly occafioned by the ferous fluid
exhaled into the upper parts conltantly
T 4 falling
288 PRACTICE
falling down to the lower ; fo the iflues
now mentioned, by evacuating the water
from thefe upper parts, may very much
relieve the whole of the difeafe. Unlefs,
however, the iflues be put in before the
difeafe is far advanced, and before the
parts have very much loft their tone, the
places of the ifTues are ready to become
afFedled with gangrene.
Some praftical writers have advifed the
employment of fetons for the fame purr
pofe that I have propofed ifTues ; but I
apprehend, that fetons will be more liable
than iiTues to the accident juft now men-
tioned.
MDCLXX1X.
For the purpofe of drawiqg out ferum
xrom anafarcous limbs, blifters have been
applied to them, and fometimes with great
fuccefs ; but the bliftered parts are ready
to
O F P II Y S I C. 289
to have a gangrene come upon them. Bli-
stering is therefore to be employed with
great caution ; and perhaps only in the
rircumftances that I have mentioned above
to be fit for the employment of iflues.
MDCLXXX.
Colewort-leaves applied to the fkin, rea-
dily occafion a watery exfudation from its
furface ; and applied to the feet and legs
affetfled with anafarca, have fometimes
drawn off the water very copioufly, and^ ^ c^JA. ^
with great advantage. ^&^:+yr^&>J/t~
Analogous, as I judge, to this, oiled filk- t£fc^_
hofe put upon the feet and legs, fo as to fhut
out all communication with the external
air, have been found fometimes to draw a
quantity of water from the pores of the
fkin, and are faid in this way to have re-
lieved anafarcous fwellings: butinfeveral
trials made, I have never found either the
appli-
290 PRACTICE
application of thefe hofe, or that of the
colewort-leaves, of much fervice.
MDCLXXXI.
The 2d means propofed in MDCLXXVL
for drawing off the water from dropfkal
places, may be the employment of eme-
tics, purgatives, diuretics, or fudorifics.
MDCLXXXH.
As fpontaneous vomiting has fome-
times excited an abforption in hydropic
parts, and thereby drawn off the waters
lodged in them, it is reafonable to fuppofe
that vomiting excited by art may have the
fame effect ; and accordingly it has been
often pra&ifed with advantage. The prac-
tice, however, requires that the ftrong
antimonial emetics be employed, and that
they
OF r II Y S I C, 291
they be repeated frequently after fhort in-
tervals. /* 4 %+dmm\
MDCLXXXIII.
Patients fubmic more readily to the ufe
of purgatives, than to that of emetics;
and indeed they commonly bear the for-
mer more eafily than the latter. At the
fame time, there are no means we can em-
ploy to procure a copious evacuation of
ferous fluids with greater certainty than
the operation of purgatives ; and it is up-
on thefe accounts chat purging is the eva-
cuation which has been moft frequently,
and perhaps with moft fuccefs, employed
in dropfy . Ic has been generally found ne-
ceffary to employ purgatives of the more
draftic kind; which are commonly known, .
and need not be enumerated here. 1 be-
lieve indeed, that the more draftic purga- ■ -A*v,
rives arc the moft effedual for exciting ab- £J* {#£ >—/
■/' >- ' ■'•■ 4 ,1 J
± /■***
2gi PRACTICE
<jC-$~« *£+&*** forption, as their ftimulus is moft readily
^_ t*& ij /7^v. communicated to the other parts of the fy-
'i^y7 O xJ^^-tm > ^ut °^ 'ate an 0piQi°n has prevailed,
««^&+».c~**±~>~ that fome milder purgatives may be em-
/-^ #/> /^
^ / ' ployed with advantage. This opinion has
#~ A<J— ^ ^ _ prevailed particularly with regard to the
tjiT> 4L/^^ cryftals vulgarly called the Cream of Tar-
W>0t^ tar, which in large dofes, frequently re-
peated, have fometimes anfwered the pur-
pofe of exciting large evacuations both by
ftool and urine, and has thereby cured
dropfies. This medicine, however, has
frequently failed, both in its operation
and effects, when the draftic purgatives
have been more fuccefsful.
Practitioners have long ago obferved,
that, in the employment of purgatives,
ic is requifite they be repeated after as
fliort intervals as the patient can bear;
probably for this reafon, that when the
purging is not carried to the degree of
foon exciting an abforption, the evacua-
tion
^
O F P H Y S I C. 293
tion weakens the fyftem, and thereby in-
creafes the afflux of fluids to the hydropic
parts.
MDCLXXXIV.
The kidneys afford a natural outlet for
a great part of the watery fluids contained
in the blood- veffels ; and the increafing
the excretion by the kidneys to a confider-
able degree, is a means as likely as any
other of exciting an abforption in dropfical
parts. It is upon this account that diure-
tic medicines have been always properly
employed in the cure of dropfy. The va- ^
rious diuretics that may be employed, are^~^;L^. <^C_
enumerated in every treatife of the Mate-"°~'w *~~ ^^
ria Medica and of the Practice of Phyfic,r/^ ,l Jfc JU,.
and therefore need not be repeated here/'~^7r7" '
It happens, however, unluckily, that none A-^ ^ n~« L*~
of them are of very certain operation \~j*j , £
neither is it well known why they fome- '-ftirffi- st^yi.
times L„z ^LJJ
+c> ~ #l &£**»ju^t V4L — — /- #/**£* - *=■/* - A •
294 PRACTICE
^l/^A^'^ < times fucceed, and why they fo often fail ;
^^^^'*°nor why one medicine fhould prove of
^A^'j/a^tc/cL fervice when another does not. Ic has been
€^l&i#il~£*& 8enera^y t^ie fault of writers upon the
6£t* .y/^/**o Pra&ice of Phyfic, that they give us in-
4vJLc+~«i~>- ~4*** Nances or caies in which certain medicines
^ZT'Jtlc <jL have proved very efficacious, but negledl
^^T^ *ft—Atity to tell us in how many other inftances the
^"^iL^orfZ^yZf fame have failed.
£- £. ~~ <*-
Jijfus^^u, MDCLXXXV.
&^ ^Jfy\r? It defer ves to be particularly obferved
^J^L^^^'. *iere» t^iac r^ere 1S hardly any diuretic more
certainly powerful than a large quantity
^/0y/^^r,-0^commo11 water taken in by drinking. I
^ftZJ^i^i have indeed obferved above, in MDCLVIII.
zadzty famUut**. tjiat a ]arge quantity of water, or of watery
..fa+Lz^ vU~u liquors, taken in by drinking, has fome-
o+jf£)££^fiL0L*f\i\mt$ proved a caufe of dropfy ; and
practitioners nave Deen iormeny 10
afraid that watery liquors taken
i drink-
OF PHYSIC. 295
drinking might run ofF into dropfical
places and increafe the difeafe, that they
have generally enjoined the abftaining, as
much as poffible, from fuch liquors. Nay,
it has been further aflerted, that by avoid-
ing this fupply of exhalation, and by a
total abftinence from drink, dropfies have
been entirely cured. What conclufion is
to be drawn from thefe fadts is, however,
very doubtful. A dropfy arifing from a
large quantity of liquids taken in to the
body has been a very rare occurrence; and
there are, on the other hand, innumerable
inftances of very large quantities of water
having been taken in and running off again
very quickly by ftool and urine, without
producing any degree of dropfy. With re-
fped to the total abftinence from drink, it
is a practice of the mod difficult execution;
and therefore has been fo feldom pradifed,
that we cannot poffibly know how far it
might prove effe&ual. The pradice of gi-
ving
296 PRACTICE
ving drink very fparingly, has indeed been
often employed : but in a hundred inftan-
ces, I have feen it carried to a great length
without any manifeft advantage; while, on
the contrary, the pra&ice of giving drink
very largely has been found not only fafe,
but very often effectual in curing the dif-
eafe. The ingenious and learned Dr Mill-
man has, in my opinion, been commend-
ably employed in reftoring the practice of
giving large quantities of watery liquors
for the cure of dropfy. Not only from
the inftances he mentions from his own
pra&ice, and from that of feveral eminent
phyficians in other parts of Europe, but
alfo from many inftances in the records
of phyfic, of the good effe&s of drinking
large quantities of mineral waters in the
cure of dropfy, I can have no doubt of the
pra&ice recommended by Dr Millman
being very often extremely proper. I ap-
prehend it to be efpecially adapted to thofe
cafes
OF PHYSIC. 297
cafes in which the cure is chiefly attempt-
ed by diuretics. It is very probable,
that thefe medicines can hardly be carried
in any quantity to the kidneys without
being accompanied with a large portion of
water ; and the late frequent employment
of the cryftals of tartar has often ihown,
that the diuretic effects of that medicine
are almoft only remarkable when accom-
panied with a large quantity of water ;
and that without this, the diuretic effects
of the medicine feldom appear. I fhall
conclude this fubject with obferving, that
as there are fo many cafes of dropfy abfo-
lutely incurable, the practice now under
confitderation may often fail, yet in mod
cafes ic may be fafely tried ; and if it ap-
pear that the water taken in paffes readily
by the urinary fecretion, and efpecially
that it increafes the urine beyond the
quantity of drink taken in, the practice
may probably be continued with great
Vol. IV. U ad-
T
298 PRACTICE
advantage : but, on the contrary, if the
urine be not increafed, or be not even in
proportion to the drink taken in, it may-
be concluded, that the water thrown in
runs off by the exhalants, and will aug-
ment the difeafe.
MDCLXXXVI.
Another fet of remedies which may be
employed for exciting a ferous excretion,
and thereby curing dropfy, is that of fu-
vL bdntu^+uc^ dorifics. Such remedies, indeed, have been
^ iid&t^.i^U^ fometimes employed: but however ufeful
i^vV. they may have been thought, there are few
accounts of their having effected a cure ;
and although I have had fome examples of
their fuccefs, in moft inftances of their
trial they have been ineffectual.
Upon this fubjeel it is proper to take
notice of the feveral means that have been
propofed and employed for diffipating the
humi-
O F P H Y S I C. 299
humidity of the body ; and particularly
that of heat externally applied to the fur-
face of it. Of iuch applications I have
had no experience ; and their propriety
and utility mud reft upon the credit of
the authors who relate them. 1 fliall offer
only this conjecture upon the fubject :
That if fuch meafures have been truly ufe-
ful, as it has feldom been by the drawing
out of any fenfible humidity, it has pro-
bably been by their ^eftoring the perfo-
ration, which is fo often greatly diminiflied
in this difeafe; or, perhaps, by changing
the ftate of the fkin, from the imbibing
condition which is alleged to take place,
into that of perfpiring.
MDCLXXXVII.
When, by the feveral means now men-
tioned, we ihall have fucceeded in eva-
cuating the water of dropfies, there will
U 2 then
3oo PRACTICE
then cfpecially be occafion for our third
indicacion; which is, to reftore the tone of
the fyftem, the lofs of which is fo often
the caufe of the difeafe. This indication,
indeed, may properly have place from the
very firft appearance of the difeafe; and
certain meafures adapted to this purpofe
may, upon fuch firft appearance, be era-
ployed with advantage. In many cafes of
a moderate difeafe, I am perfuaded that
they may obviate any future increafe of it,
MDCLXXXVI1I.
Thus, upoa what is commonly the firft
fymptom of anafarca, that is, upon the
appearance of what are called ©edematous
Swellings of the feet and legs, the three
remedies of bandaging, friction, and ex-
ercife, have often been ufed with advan-
tage,
MDCLXXXIX.
j
O F P H Y S I C. 301
MDCLXXX1X.
That fomc degree of external comprcf-
fion is fuited to fupport the tone of the
vefTels, and particularly to prevent tiie ef-
fects of the weight of the blood in dilating
thofe of the lower extremities, mud be
lufficiently evident; and the giving that
compreffion by a bandage properly applied,
has been often ufeful. In applying fuch
a bandage, care is to be taken that die
compreffion may never be greater on the
upper than on the iower part of the limb j
and this, I think, can hardly ever be fo
certainly avoided, as by employing a pro-
perly conftru&ed laced (locking.
MDCXC.
Friction is another means by which the
acYion of the blood-veffels may be promo-
U 3 ted,
302 PRACTICE
ted, and thereby the ftagnation of fluids in
their extremities prevented. Accordingly,
the ufe of the flefh-brufh has often contri-
buted to difcufs ©edematous fwellings. It
appears to me, that fri&ion, for the pur-
pofes now mentioned, is more properly
employed in the morning, when the fuell-
ing is very much gone off, than in the
evening, when any confiderable degree of
it has already come on. 1 apprehend alfo,
that fricftion being made from below up-
wards only, is more ufeful than when
. %, made alternately upwards and downwards.
JLjrj£*+T- ^h\t has been common, inftead of employing
9L 1?Lu HuLi^it flefh-brufh, to make the fridion by
warm and dry flannels ; and this may in
fome cafes be the mod convenient : but I
cannot perceive that the impregnation of
thefe flannels with certain dry fumes is of
any benefit.
MDCXCL
OF P II Y S I C.
MDCXCf.
3°3
With i to exercife, I mull obfcrvc,
that although perfons being much in an
erect pofture during the day, may feem
to increafe the fvvelling which comes on at
night ; yet as the action of the mufcles has
a great ihare in promoting the motion of
the venous blood, fo I am certain, that as
much exercife in walking as the patient
can ealily bear, will often prevent that ce-
dematous fwelling, which much (landing,
and even fitting, would have brought qn.
MDCXCII.
Thefe meafures, however, although they
may be ufeful at the coming on of a drop-
ly, whofe caufes are not very powerful,
will be often infufficient in a more violent
difeafe; and fuch therefore will require
more powerful remedies. Thefe are, exer-
U 4 cife
3°4
PRACTICE
cife and tonic medicines ; which may bo
employed both during the courfe of the
difeafe, and efpecially after the water I
been evacuated.
O
MDCXCIIl.
£ t^^c sLa* Exercife is fuited to affift in every func-
^ ^^ '• x_" tion ofthe animal oeconomy, particularly
' to promote perfpiration, and thereby pre-
vent the accumulation of watery fluids in
the body. I apprehend alfo, that it may
be the mod effectual means for preventing
the fkin from being in an imbibing ftate ;
and, as has been hinted above on the fub-
jecl of Emaciation (MDCV1L), I am per-
fuaded, that a full and large perfpiration
will always be a means of exciting abforp-
tion in every part ofthe fyflem. Exercife,
therefore, promifes to be highly ufeful in
dropfy ; and any mode of it may be em-
ployed that the patient can mod conve-
niently
OF PHYSIC. 305
niently admit of. It fhould, however, al-
ways be as much as he can eaiily bear : and
in anafarca, the ihare which the exercife
of mufcles has in promoting the motion
of the venous blood, induces me to think
that bodily exercife, to whatever degree
the patient can bear it, will always be the
mod ufefuh From fome experience alfo, I
am perfuaded, that by exercife alone, em-
ployed early in the difeafe, many dropfies
may be cured.
MDCXCIV.
Befides exercife, various tonic remedies
are properly employed to reftore the tone
of the fy ftem. The chief of thefe are, cha~
lybeates, the Peruvian bark, and various
bitters. Thefe are not only fuited to re-
ftore the tone of the fyftem in general,
but are particularly ufeful in (lengthen-
ing the organs of digeftion, which in drop-
fies
m
3o6 PRACTICE
fies are frequently very much weakened :
and for the fame purpofe alfo aromatics
may be frequently joined with the tonics.
MDCXCV.
Cold bathing is upon many occaiions
the mod: powerful tonic we can employ ;
but at the beginning of dropfy, when the
debility of the fyftem is confiderable, it
can hardly be attempted with fafety. Af-
ter, however, the water of dropfies has been
very fully evacuated, and the indication is
to ftrengthen the fyftem for preventing a
relapfe, cold bathing may perhaps have a
place. It is, at the fame time, to be ad-
mitted- with caution ; and can fcarcely
be employed till the fyftem has otherwifc
recovered a good deal of vigour. When
that indeed has happened, cold bathing
may be very ufeful in confirming and com-
pleting it.
MDCXCVI.
OF PHYSIC. 307
MDCXCVI.
In perfons recovering from dropfy,
while the feveral means now mentioned
for ftrengthening the fyftem are employ-
ed, it will be proper at the fame time to
keep conflantly in view the fupporc of the
watery excretions ; and confequently the
keeping up the perfpiration by a great deal
of exercife, and continuing the full flow of
the urinary excretions by the frequent ufe
of diuretics.
SECT.
3o8 PRACTICE
SEC T. IL
0/>£<?Hydrothorax, or Dropsy of the Breas
MDCXCVIL
The preternatural collection of ferous
fluid in the thorax, to which we give the
appellation of Hydrothorax% occurs more
frequently than has been imagined. Its
prefence, however, is not always to be
very certainly known ; and it often takes
place to a confiderable degree before it be
difcovered.
MDGXCVIII.
OF PHYSIC. 309
MDCXCVIII.
Thefe collections of watery fluids in the
thorax, are found in different (ituations.
Very often the water is found at the fame
time in both facs of the pleura, but fre-
quently in one of them only. Sometimes
it is found in che pericardium alone ; but
for the mod part it only appears there
when at the fame time a collection is pre-
fent in one or both cavities of the thorax.
In fome inftances, the colledion is found to
be only in that cellular texture of the lungs
which furrounds the bronchiae, without
there being at the fame time any effufion
into the cJvity of the thorax.
Pretty frequently the water collected
confifts chiefly of a great number of hy-
datides in different fituations ; fometimes
feemingly floating in the cavity, but fre-
quently connected with and attached to
par-
310 PRACTICE
particular parts of the internal furface of
the pleura.
MDCXCIX.
From the colle&ion of water being thus
in various fituations and circumftances,
fymptoms arife which are different in dif-
ferent cafes ; and from thence it becomes
often difficult to afcertain the prefence and
nature of the affecflion. I fhall, however,
endeavour here to point out the raoft com-
mon fymptoms, and efpecially thofe of that
principal and mod frequent form of the
difeafe, when the ferous fluid is prefent in
both facs of the pleura, or, as we ufually
fpeak, in both cavities of the ttfRrax.
MDCC.
The difeafe frequently comes on with a
fenfe of anxiety about the lower part of
the fternum. This, before it has fubfift-
3 . ed
OF PHYSIC. 311
cd long, comes to be joined with fome
difficulty of breathing ; which at firft ap-
pears only upon the perfon's moving a little
fader than ufual, upon his walking up an
acclivity, or upon his afcending a flair-
cafe : but after fome time, this difficulty
of breathing becomes more conftant and
coniiderable, efpecially during the night,
when the body is in a horizontal fituation. fL?UL*n*<p*~
Commonly, at the fame time, lying upon/^T^f^^
one fide is more eafy than upon the other, #_ *ttz~*ht^*X
or perhaps lying upon the back more eafyA^
than upon either fide. Thefe circumftan-^^^^^^T
ces are ufually attended with a frequent *i^w J.~<i,
cough, that is at firft dry ; but which, aft^ ut~#
ter fome time, is accompanied with an ex- i^A/^
pecioration or thin mucus. /^.^tu
With all thefe fymptoms, the hydro- ~*f~^"^
thorax is not certainly difcovered, as xhtjjLstyf, *£~~f
fame fymptoms often attend other dif- f s/~£jL~
eafes of the bread. When, however, a- /—'*— «^> ^
long with thefe fymptoms, there is at the^ y j/Jj-
fame
3i2 PRACTICE
fame time an ocdematous fwelling of the
feet and legs, a leucophlegmatic palenefs of
the face, and a fcarcity of urine, the exift-
ence of a hydrothorax can be no longer
doubtful. Some writers have told us, that
ibmetimes in this difeafe, before the fwell-
ing of the feet comes on, a watery fwelling
of the fcrotum appears ; but I have never
met with any inftance of this.
MDCCI.
Whilft the prefence of the difeafe is
foiewhat uncertain, there is a fymptom
which fometimes takes place, and has been
thought to be a certain characteriftic of it ;
and that is, when, foon after the patient has
fallen afleep, he is fuddenly awaked with
a fenfe of anxiety and difficult breathing,
and with a violent palpitation of the heart.
Thefe feelings immediately require an erect
pofture ; and very often the difficulty of
3 breathing
OF PHYSIC, 513
breathing continues to require and to pre-
vent fleep for a great part of the night.
This fymptom I have frequently found at-
tending the difeafe ; but L have alfo met
with feveral instances in which this fymp-
tom did not appear. I mull: remark fur-
ther, that 1 have not found this fymptom
attending the empyema, or any other dif-
eafe of the thorax; and therefore, when it
attends a difficulty of breathing, accompa-
nied with any the fmalleft fymptom of
dropfy, 1 have had no doubt in concluding
the prefence of water in the cheft, and have
always had my judgment confirmed by the
fymptoms which afterwards appeared.
MDCCII.
The hydrothorax often occurs with
very few, or almoft none, of the fymp-
toms above mentioned ; and is not,' there-
fore, very certainly difcovered till fome
Vot.1V X others
,
3i4 PRACTICE
others appear. The mod decifive fymp-
torn is a ftu&uation of water in the cheft,
perceived by the patient himfelf, or by the-
phyfician, upon certain motions of the
body. How far the method propofed by
Auenbrugger will apply to afcertain the
prefence of water and the quantity of it in
the cheft, I have not had occafion or op-
portunity to obferve.
It has been faid, that in this difeafe fome
tumour appears upon the fides or upon the
(fau fo<^.c+^<f back; but I have not met with any in-
<f/~y~] Jfc~-. fiance of this. In one inftance of the dif-
ceafe, I found one fide of the thorax con-
fiderably enlarged, the ribs ftanding out
farther on that fide than upon the other.
A numbnefs and a degree of palfy in one
or both arms, has been frequently obfer-
ved to attend a hydrothorax.
Soon after this difeafe has made fome
progrefs, the pulfe commonly becomes ir-
regular, and frequently intermitting : but
this
OF PHYSIC. 315
this happens in fo many other difeafes of
the breaft, that unlefs when it is attended
with fome other of the above-mentioned
fymptoms it cannot be ccnfidered as de-
noting the hydrothorax.
MDCCIIL
This difeafe, as other dropfies, is com-
monly attended with thirfland a fcarcity of
urine, to be explained in the fame manner
as in the cafe of anafarca (MDCLXXIII.)
The hydrothorax, however, is fometimes
without third, or any other febrile fymp-
tom ; although I believe this happens in
the cafe of partial affections only, or when
a more general affecfliori is yet but in a
flight degree. In both cafes, however, and
more efpecially when the difeafe is confi-
derably advanced, fome degree of fever is
generally prefent : and I apprehend it to
be in fuch cafe, that the perfons affe&ed
are more than ufually fenfible to co-ld, and
X t com-
3*6 PRACTICE
complain of the caldnefs of the air when
that is not perceived by other perfons.
MDCCIV.
The hydrothorax fometimes appears a-
lone, without any other ipecies of dropfy
being prefent at the fame time : and in this
cafe the difeafe, for the molt part, is a par-
tial affection, as being either of one fide of
the thorax only, or being a colledion of
hydatides in one part of the cheft. The
hydrothorax, however, is very often a
part of more univerfal dropfy, and when
at the fame time there is water in all the
three principal cavities and in the cellular
texture of a great part of the body. 1 have
met with feveral inftances, in which fuch
univerfal dropfy began firft by an effufion
into the thorax. The hydrothorax, how-
ever, more frequently comes on from an
anafarca gradually increafing ; and, as I
have
OF PHYSIC. 317
have faid above, the general diathefis feems
often to affedl the thorax fooner than it
does either the head or the abdomen.
MDCCV.
This difeafe feldom admits of a cure, or
even of alleviation, from remedies. It
commonly proceeds to give more and more
difficulty of breathing, till the adion of
the lungs be entirely interrupted by the
quantity of water efFufed ; and the fatal
event frequently happens more fuddenly Sl^^^fLt*^
than was expe&ed. In many of the in-^L,^ ^L> ~*,y
fiances of a fatal hydrothorax, 1 have re- a a^C/La* — *
marked a fpitting of blood to come on fe-y^ T^lKk J!l2
veral days before the patient died. fS£fr^~^
MDCCVI. f&ZL - &^
The caufe of hydrothorax is often mk-/2^u*A- . *
nifeftly one or other of the general caufes
X3 of •
i
3i8 PRACTICE
of dropfy pointed out above : but what it
is that determines thefe general caufes to
a6l more efpecially in the thorax, and par-
ticularly what it is that produces the par-
tial collections that occur there, I do not.
find to be eauly afcertained,
MDCCV1L
From what has been faid above, it will
be evident, that the cure of hydrothorax
Tnuft be very much the fame with that of
anafarca ; and when the former is joined
with the latter as an effeft of the fame ge-
neral diathelxs, there can be no doubt of
the method of cure being the fame in
]Doth. Even when the hydrothorax is a-
lone, and the difeafe partial, from parti-
cular caufes acting in the thorax only,
there can hardly be any other meafures
employed, than the general ones propofed
above. There is only one particular mea-
fure
OF PHYSIC, 319
fare adapted to thehydrothorax; and that
is, the drawing off the accumulated waters
by a paracemefis of the thorax.
MDCCVIH.
To what cafes this operation may be
mod properly adapted, I find it difficult
to determine. That it may be executed
with fafety, there is no doubt ; and that it
has been fometimes praclifed with fuccefs,
feems to be very well vouched. When ^~-~ */*,T/
the difeafe depends upon a general hydro- •&>-/- 9f%*&*
pic diatheiis, it cannot alone prove a cure,^w ,w*^-
but may give a temporary relief; and^j^7*^"^
when other remedies feem to be employed J^*^ J**t*<&
with advantage, the drawing ofF the wa-y^^^^^iL
ter may very much favour a complete T(ftmyy J%>
cure. 1 have not, however, been fo fortu-
nate as to fee it practifed with any fuccefs;
and even where it was moil promifing,
X 4 that
520 PRACTICE
that is, in cafes of partial affection, my
expectations have been difappointed from
it.
ECT.
OP PHYSIC, 321
SECT. III.
Of Ascites, or Dropsy of the Lower Beli,t<
MDCCIX.
The name of AJ cites is given to every
collection of waters caufing a general fwell-
ing and diftention of the lower belly; and
fuch collections are more frequent than
thofe which happen in the thorax.
MDCCX.
The collections in the lower belly, like
thofe of the thorax, are found in different
fitua-
322 PRACTICE
filiations. Mod commonly they are in
the fac of the peritonaeum, or general ca-
vity of the abdomen : but they often be-
gin by facs formed upon, and connected
with, one or other of the vifcera ; and per-
haps the mod frequent inftances of this
kind occur in the ovaria of females. Some-
times the water of afcites is found entirely
without the peritoneum, and between this
and the abdominal mufcles.
MDCCXL
Thefe collections connected with parti-
cular vifcera, and thofe formed without
the peritonaeum, form that difeafe which
authors have termed the ennjled dropfy or
hydrops faccatus. Their precife feat, and
even their exiftence, is very often difficult
to be afcertained. They are generally
formed by collections of hydatides.
MDCCXIL
0 F PHYSIC 323
MDCCXII.
In the mod ordinary cafe, that of ab-
dominal dropfy, the fwelling at flrft is in
fome meafure over the whole belly, but
generally appears moft confiderable in the
epigaftrium. As the difeafe, however, ad-
vances, the fwelling becomes more uniform
over the whole. The diftention and fenfe
of weight, though confiderable, vary a
little according as the pofture of the body
is changed ; the weight being felt the moft
upon the fide on which the patient lies,
while at the fame time on the oppofite fide
the diftention becomes fomewhat lefs. In
almoft all the inftances of afcites, the fluc-
tuation of the water within, may be per-
ceived by the practitioner's feeling, and
fometimes by his hearing. This percep-
tion of fluctuation does not certainly di-
ftinguifh the different ftates of dropfy ; but
ferves very well to diftinguifh dropfy from
tym-
3*4 PRACTICE
tympanites, from cafes of ^hyfconia, and
from the ftate of pregnancy in women.
MDCCXIII.
An afcites frequently occurs when no
other fpecies of dropfy does at the fame
time appear; but fometimes the afcites
is a part only of univerfal dropfy. In
this cafe, it ufually comes on in confe-
quence of an anafarca, gradually increa-
fing ; but its being joined with anafarca,
does not always denote any general dia-
thefis, as for the mcft part an afcites foon-
er or later occafions cedematous fwellings
of the lower extremities. When the col-
ledlon of water in the abdomen, from
whatever caufe, becomes confiderable, it
is always attended with a difficulty of
breathing : but this fymptom occurs often
when, at the fame time, there is no water
in the thorax. The afcites is fometimes
2 un-
O V PHYSIC. 325
unaccompanied with any fever; but fre-
quently there is more or lefs of fever pre-
fect with it. The difeafe is never coniide-
rable, without being attended with third
and a fcarcity of urine.
MDCCXIV.
In the diagnofis of afcites, the greateft
difficulty that occurs, is in difcerning when
the water is in the cavity of the abdomen,
or when it is in the different ftates of en-
cyfted dropfy above mentioned. There
is, perhaps, no certain means of afcertain-
ing this in all cafes ; but in many we may
attempt to form fome judgment with re-
gard to it.
When the antecedent circumftances
give fufpicion of a general hydropic dia-
thefis ; when at the fame time fome de-
gree of dropfy appears in other parts of
the body; and when, from its firfl: appear-
ance, the fwelling has been equally over
the
326 PRACTICE
the whole belly, we may generally pre-
fume that the water is in the cavity of the
abdomen. But when an afcites has not
bzen preceded by any remarkable cachec-
tic ftate of the fyftem, and when at its
beginning the tumour and tenflon had
appeared in one part of the belly more
than another, there is reafon to fufpedt an
encyfted dropfy. Even when the tenfion
and tumour of the belly have become ge-
neral and uniform over the whole ; yet if
the fyftem of the body in general appear to
be little affeded ; if the patient's ftrength
be little impaired ; if the appetite conti-
nue pretty entire, and the natural fleepf
be little interrupted ; if the menfes in fe-
males continue to flow as ufual ; if there
be yet no anafarca ; or, though it may have
already taken place, if it be ftill confined
to the lower extremities, and there be no
leucophlegmatic palenefs or fallow colour
in the countenance ; if there be no fever^
4 nor
O F V II Y S I C. 327
nor to much thirft, or fcarcity of urine, as
occur in a more general affection ; then,
according as more of thefe different cir-
cumftances take place, there will be the
ftronger ground for fuppollng the afcitcs
to be of the encyfted kind.
The chief exception to be made from this
as a general rule, will, in my opinion, be
when the afcites may, with much probabi-
lity, be prefumed to have come on in con-
fequence of a fcirrhous liver ; which, I ap-
prehend, may occafioji a colledtion of wa-
ter in the cavity of the abdomen, while the
general fyftem of the body may not be o-
therwife much affected.
MDCCXV.
With refpect to the cure of afcites
when of the encyfted kind, it does not, fo
far as 1 know, admit of any.* When the* ";7
collection of water is in the abdominals, - ufc,&/
cavity alone, without any other fpecies ^/2a*Ta!S
dropfy
K?^e*-/>- to />
328 PRACTICE
dropfy prefent ac the fame time, I appre-
hend the afcites will always be of difficult
cure ; for it may be prefumed to depend
upon a fcirrhofity of the liver, or other
confiderable affedtion of the abdominal
vifcera, which I conceive to be of very dif-
ficult cure, and therefore the afcites de-
pending upon them. At the fame time,
fuch cafes may often admit of a temporary
relief by the paracentefis.
MDCCXVI.
When the afcites is a part of univerfal
dropfy, it may, as far as other cafes of chat
kind can, admit of a cure ; and it will be
obvious, that fuch a cure mud be obtained
by the fame means as above propofed for
the cure of general anafarca.
It frequently happens, that the afcites is
attended with a diarrhoea ; and, in that
cafe, does not admit of the ufe of purga-
I1TCS
OF PHYSIC. 329
iivts fo freely as oiks of anaf-rca com-
monly do. It is therefore often to be
treated by diuretics almott alone.
The diuretics that may be employed,
are chiefly thofe above mentioned ; but in
afcites, a peculiar one has been found out.
It is a long- continued gentle friction of the
flvin over the whole of the abdomen, by
the fingers dipped in oil. This has fome- r0&**~d<fy*4L
times been ulerul in exciting an lncreaied^-^ j^^
flow of urine; but in molt of the trials of 7^ *0^*~
it which 1 have known made, it has failed^.,0 &-<s*+*^
in producing that effect.
MDCCXVII.
The afcites admits of a particular means
for immediately drawing off the collec-
ted waters ; and that is the well-known
operation of the paracentefis of the abdo-
men. In what circumftances of afcites Je**&* ■->/_
this operation can molt properly be pro- m
Vol. IV. Y poied,|^~?'
j3o PRACTICE
pofed, it is difficult to determine ; but, fc
far as I can judge, it muft be regulated by
very much the fame confiderations as
thofe above mentioned with regard to the
paracentefis of the thorax.
The manner of performing the paracen-
tefis of the abdomen, and the precautions
to be taken with refpect to it, are now fo
commonly known, and delivered in fo
many books, that it is altogether unnecef-
fary for me to offer any diredlions upon
that fubjedl here; efpecially after the full
and judicious information and diredlions
given by Mr Bell, in the fecond volume
of his Syjlem of Surgery.
CHAP,
OF PHYS1 C 5
C II A P. IV
OfGeneral Swellings, arising trom
an increased bulk of the whole
Substance of particular Parts,
MDCCXVIII.
UPON the fubjects of this chapter, fe-
veral nofological difficulties occur,
and particularly with refped to admitting
the Phyfconia into the order of General
Swellings. At prefent, however j it is not
neceffary for me to difcufs this point, as I
am here to omit entirely the confidera-
Y 2 tion
3j2 PRACTICE
tion of Phyfconia ; both becaufe it can fel-
dom admit of any fuccefsful practice, and
becaufe I cannot deliver any thing ufeful
either with regard to the pathology or
practice in fuch a difeafe.
MDCCXIX.
The only other genus of difeafe com-
prehended under the title of the prefent
chapter, is the Rachitis ; and this being
both a proper example of the clafs of Ca-
chexy', and of the order of Intumefcenti<z or
General Swellings, I fliall offer fome ob-
fervations with regard to it.
Of Rachitis, or Rickets.
MDCCXX.
This difeafe has been fuppofed to have
appeared only in modern times, and not
above two hundred years ago. This opi-
nion,
O F P H Y S I C. 333
nion, notwithftanding it has been main-
tained by perfons of the mod refpedable *■
authority, appears to me, from many con- « . ;/,„ t ,.*<w~
fiderations, improbable ; but it is a poiHtl-g^^r **\
of too little confequence to detain my ^ tfU*4&
readers here. The only application of it,,
-»!*.-« *■ ?*-*< > -*
which deferves any notice is, that it has"; /. r" /
led to a notion of the difeafe having ari fen a -< J J *^y
from the lues venerea, which had certain- \/&4t&Jk-&**».
ly made its firft appearance in Europe not^/^/^^y^
very long before the date commonly at- -y~~»& *7r~^
iigned for the appearance of rachitis : but
I lhall hereafter mow, that the fuppofed
connexion between the Siphylis and Ra-
chitis is without foundation.
MDCCXXI.
In delivering the hiftory of the Rickets, I
muft, in the firft place, obferve, that with
refpedl to the antecedents of the difeafe, e-
very thing to be found in authors upon
Y 3 this
w
334 PRACTICE
this fubjetft, appears to me to reft upon a
very uncertain foundation. In particular,
with refpeel to the ftate of the parents
whofe offspring become affecled with this
difeafe, I have met with many inftances of
it, in children from feemingly healthy pa-
rents; and have met likewife with many
inftances of children who never became
affected with it, although born of parents
who, according to the common accounts,
fhould have produced a rickety offspring :
fo that, even making allowance for the
^/^ flr ^-uncertainty of fathers, I do not find the
SS tH* riLy* £enera* °pini°n of authors upon this fub~
CL£><^ MfCsDjeft to be properly fupported.
<0«£^/^clt^> ~ ' MDCCXXII.
The difeafe, however, may be juftly
coniidercd as proceeding from parents; for
it often appears in a great number of the
fame family : and my obfervation leads
me
OF PHYSIC. 3i,
me to judge, that ic originates more fre-
quently from mothers than from fathers.
So far as I can refer the difeafe of the
children to the ftate of the parents, it has
appeared to me moil commonly to arife
from ibme wcaknefs, and pretty frequently
from a fcrophulous habit, in the mother.
To conclude the fubje<5t, I muft remark,
that in many cafes I have not been able to
difcern the condition of the parents, to
which I could refer it.
When nurfes,*other than the mothers/^
<uv«
e-
has been fuppofed that fuch nurfes have*^" 'o'
have been employed to fuckle children, it^/.^
&
requently given occafion to the difeafe :<?*-~«
and when nurfes have both produced and
have fuckled children who became ric-
kety, there may be ground to fufpeel their
having occafioned the difeafe in the chil-
dren of other perfons : but I have had
few opportunities of afcertaining this mat-
ter. It has in fome meafure appeared
Y4 to
5$6 PRACTICE
to me, that thofe nurfes are mod likely to
produce this difeafe, who give infants a
large quantity of very watery milk, and
who continue to fuckle them longer than
the ufual time. Upon the whole, how-
ever, I am of opinion, that hired nurfes fel-
dom occafion this difeafe, unlefs when a
predifpofition to it has proceeded from the
parents.
MDCCXXIIL
With regard to the other antecedents,
which have been ufually enumerated by
authors as the remote caufes of this dif-
eafe, I judge the accounts given to be ex-
tremely fallacious ; and i am very much
perfuaded, that the circumftances iji the
rearing of children, have lefs effeft in pro-
ducing rickets than has been imagined. It
is indeed not unlikely, that fome of thefe
circumftances mentioned as remote caufes
may
OF PHYSIC, 33;
may favour, while other circumftanccs
may refill, the coming on of the difeafe ;
but at the fame time, I doubt if any of
the former would produce it where there
was no predifpofition in the child's ori-
ginal conftitution. This opinion of the
remote caufes, I have formed from ob-
ferving, that the difeafe comes on when
none of thefe had been applied; and more
frequently that many of them had been
applied without occafioning the difeafe.
Thus the learned Zevi ani alleges, that the
difeafe is. produced by an acid from the
milk with which a child is fed for the firfl:
nine months of its life: but almoft all
children are fed with the fame food, and
in which alfo an acid is always produced ;
while, at the fame time, not one in a thou-
fand of the infants fo fed becomes affec-
ted with the rickets. If, therefore, in the
infants who become aiTe&ed with this dif-
eafe, a peculiarly noxious acid is produ-
ced,
r
338 PRACTICE
ceJ, we mult feek for fome peculiar caufe
of its produ&ion, either in the quality of
the milk, or in the conftitution of the
child ; neither of which, however, Mr Ze-
viani has explained. 1 cannot indeed be-
lieve that the ordinary acid of milk has
any {hare in producing this difeafe, be-
caufe I have known many inftances of the
acid f being produced and occafioning va-
rious diforders, without, however, its ever
producing rickets.
Another of the remote caufes commonly
affigned, is the child's being fed with un-
fyti* - ^^ fermented farinaceous food. But over the
(/&*u&*,*~*/ whole world children are fed with fuch
farinacea, while the difeafe of rickets is a
rare occurrence : and 1 have known many
inftances where childrenhavebeen fed with
a greater than ufual proportion of fermen-
ted farin acea, and alfo a greater proportion of
animal food, without thefe preventing the
difeafe. In my apprehenfion, the likeob-
fei>
o f'imiysi c.
fervatioiH mig with refpcct to
moil of the circuit!- that have beer.
mentioned of ricketr.
mi xiv.
Having thus offered my opinion con-
cerning the fuppofed antecedents of this
difeafe, I proceed now to mention the phe-
nomena occurring after it has actually
come on.
The difeafe feldom appears before the
ninth month, and feldom begins after the
fecond year, of a child's age. In the in-
terval between thefe periods, the appear-
ance of the difeafe is fometimes fooner,
lbmetimes later; and commonly at firfl: the
difeafe comes on flowly. The firft ap-
pearances are a flaccidity of the flefh, the
body at the fame time becoming leaner,
though food be taken in pretty largely.
The head appears large with refpefl to the
body ;
340 PRACTICE
body; with the fontanelle, and perhaps the
futures, more open than ufual in children
of the fame age. The head continues to
grow larger ; in particular, the forehead
becoming unufually prominent; and at the
fame time the neck continues flender, or
feems to be more fo, in proportion to the
head. The dentition is flow, or much
later than ufual ; and thofe teeth which
come out, readily become black, and fre-
quently again fall out. The ribs lofe their
convexity, and become flattened on the
fides ; while the fternum is pufhed out-
ward, and forms a fort of ridge. At the
fame time, or perhaps fooner, the epiphy-
fes at the feveral joints of the limbs be-
come fwelled; while the limbs between the
joints appear, or perhaps actually become,
more flender. The bones feem to be every
where flexible, becoming varioufly diftort-
ed; and particularly the fpine of the back
becoming incurvated in different parts of
its
OF PHYSIC. 34i
its length. If the child, at the time the dif-
eafe comes on, had acquired the power ot
walking, it becomes daily more feeble in its
motions, and more averfe to the exertion of
them, lofing at length the power of walk-
ing altogether. Whilft thefe fymptoms
go on increafing, the abdomen is always
full, and preternaturally tumid. The ap-
petite is often good, but the (tools are ge-
nerally frequent and loofe. Sometimes the
faculties of the mind are impaired, and
ftupidity or fatuity prevails; but com-
monly a premature fenfibility appears, and
they acquire the faculty of fpeech fooner
than ufual. At the firft coming on of
the difeafe, there is generally no fever at-
tending it ; but it feldom continues long,
till a frequent pulfe, and other febrile
fymptoms, come to be conftantly prefent.
With thefe fymptoms the difeafe proceeds,
and continues in fome inftances for fome
years; but very often, in the courfe of
that
/
342 PRACTICE
that time, the difeafe ceafes to advan
and the health is entirely eftablifhed, ex-
cept that the diftorted limbs produced du-
ring the difeafe continue for the reft of
life. In other cafes, however, the difeafe
proceeds increafing till it has affe&ed al-
moft every function of the animal oecono-
my, and at length terminates in death.
The variety of fymptoms which in fuch
cafes appear, it does not feem neceffary
to enumerate, as they are not efTential to
the conftitution of the difeafe, but are
merely confequences of the more violent
conditions of it. In the bodies of thofe
who have died, various morbid affections
have been difcovered in the internal parts.
Mod of the vifcera of the abdomen have
been found to be preternaturally enlarged.
The lungs have aifo been found in a mor-
bid ftate, feemingly from fome inflam-
mation that had come on towards the end
of the difeafe. The brain has been com-
4 monly
V
OF PHYSIC. 343
monly found in a flaccid Hate, with cffu-
fions of a ferooa fluid into its cavities.
Very univerfally the bones have been found
very foft, and lb much foftcned as to be
readily cut by a knife. The fluids have
been always found in a diflblved ftate, and
the mufcular parts very foft and tender;
and the whole of the dead body without
any degree of that rigidity which is fo
common in almoft all others.
MDCCXXV.
From thefe circumftances of the difeafe,
it feems to confift in a deficiency of that
matter which fhould form the folid parts
of the body. This efpecially appears in
the faulty ftate of offification, feemingly
depending upon the deficiency of that
matter which fhould be depofited in the
membranes which are deflined to become
bony, and fhould give them their due firm-
nefs
34+ PRACTICE
nefs and bony hardnefs. It appears that
this matter is not fupplied in due quanti-
ty ; but that in place of it, a matter fitted
to increafe their bulk, particularly in the
epiphyfes, is applied too largely. What
this deficiency of matter depends upon, is
difficult to be afcertained. It may be a
fault in the organs of digeftion and afli-
milation, which prevents the fluids in ge-
neral from being properly prepared ; or it
may be a fault in the organs of nutrition,
which prevents the fecretion of a proper
matter to be applied. With refpedt to the
latter, in what it may confift, I am en-
tirely ignorant, and cannot even difcern
that fuch a condition exifts: but the former
caufe, both in its nature and existence, is
more readily perceived; and it is probable
that it has a confiderable influence in the
matter ; as in rachitic perfons a thinner
Hate of the blood, both during life and af-
ter death, fo commonly appears. It is this
ftate
\
O F P H Y S I C. 345
ftate of the fluids, or a deficiency of bony
matter in them, that I confider as the proxi-
mate caufe of the difeafe ; and which a-
gain may in fome meafure depend upon
a general laxity and debility of the moving
fibres of the organs that perform the func-
tions of digeftion and aflimilation.
MDCCXXVL
There is, however, fomething flill want-
ing to explain, Why thefe circumftances
difcover themfelves at a particular time of
life, and hardly ever either before or after
a certain period ; and as to this I would
offer the following conjectures. Nature
having intended that human life fhould
proceed in a certain manner, and that cer-
tain functions fliould be exercifed at a cer-
tain period of life only ; fo it has general-
ly provided, that at that period, and not
fooner, the body fliould be fitted for the ex-
Vql. IV, Z ercife
346 PRACTICE
ercife of the fun&ions fuited to it. To ap-
ply this to our prefent fubjedt, Nature feems
to have intended that children fhould walk
only at twelve months old ; and according-
ly has provided, that againft that age, and
no fooner, a matter fhould be prepared fit
to give that firmnefs to the bones which U
neceflary to prevent their bending too ea-
fily under the weight of the body. Nature,
however, is not always fleady and exadl
in executing her own purpofes ; and if
therefore the preparation of bony matter
fhall not have been made againft the
time there is particular occafion for it,
the difeafe of rickets, that is, of foft and
flexible bones, muft come on ; and will
difcover itfelf about the particular pe-
riod we have mentioned. Further, it will
be equally probable, that if at the pe-
riod mentioned the bones fhall have ac-
quired their due firmnefs, and that nature
goes on in preparing and fupplying the
pro-
OF PHYSIC. 347
proper bony matter, it may be prefumed,
that againft the time a child is two years
old, fuch a quantity of bony matter will
be applied as to prevent the bones from
becoming again foft and flexible during
the reft of life ; unlefs it happen, as in-
deed it fometimes does, that certain cau-
fes occur to wafli out again the bony
matter from the membranes in which ic
had been depofited. The account I have
now given of the period at which the
rickets occur, feems to confirm the opi-
nion of its proximate caufe being a defi-
ciency of bony matter in the fluids of the
body.
MDCCXXVIL
It has been frequently fuppofed, that a
fiphylitic taint has a fhare in producing
rickets; but fuch afuppofition is altogether
improbable. If our opinion of the rickets
Z 2 ha-
348 PRACTICE
having exifted in Europe before the fit-
phylis was brought into it, be well found-
ed, it will then be certain that the dif-
eafe may be occafioned without any fi-
phylitic acrimony having a (hare in its
production. But further, when a fiphy-
litic acrimony is tranfmitted from the pa-
rent to the offspring, the fymptoms do not
appear at a particular time of life only,
and commonly more early than the period
of rickets ; the fymptoms alfo are very
different from thofe of rickets, and unac-
companied with any appearance of the
latter ; and, laftly, the fymptoms of fi-
phylis are cured by means which, in the
cafe of rickets, have either no efFedl, or a
bad one. It may indeed pofGbly happen,
that fiphylis and rickets may appear in the
fame perfon ; but it is to be confidered
as an accidental complication : and the
very few inftances of it that have occur-
red, are by no means fufficient to eftablifh
any
OF PHYSIC.
;49
any neceiFary connexion between the two
difeafes.
MDCCXXVIII.
With refpect to the deficiency of bony
matter, which I confider as the proximate
caufe of rickets, fome further conjectures
might be offered concerning its remote
caufes : but none of them appear to me
very fatisfying ; and whatever they might
be, it appears to me they muft again be
refolved into the fuppofition of a general
laxity and debility of the fyftem.
MDCCXXIX,
It is upon this fuppofition almoft alone
that the cure of rickets has entirely pro-
ceeded. The remedies have beea fuch
efpecially as were fuited to improve the
tone of the fyftem in general, or of the
Z 3 ftomach
3jo PRACTICE
ftomach in particular : and we know that
the latter are not only fuited to improve
the tone of the ftomach itfelf, but by that
means to improve alfo the tone of the
whole fyftem,
MDCCXXX.
Of tonic remedies, one of the raoft pro-
mifing feems to have been cold bathing ;
and I have found it the moft powerful in
preventing the difeafe. For a long time
pad, it has been the praftice in this coun-
try, with people of all ranks, to wafti
their children from the time of their birth
with cold water ; and from the time that
children are a month old, it has been the
pradtice with people of better rank to have
them dipped entirely in cold water every
morning : and wherever this practice has
been purfued, I have not met with any in-
fiance of rickets. Amongft our common
people,
O F P H Y S I C. 351
people, although they wafh their children
with cold water only, yet they do not fo
commonly pradile immerfion : and when
amongft thefe 1 meet with inftances of
rickets, I prefcribe cold bathing ; which
accordingly has often checked the progrefs
of the difeafe, and fometimes ieems to have
cured it entirely,
MDCCXXXI.
The remedy of Ens Veneris, recommend-
ed by Mr Boyle, and fince his time very
univerfally employed, is to be confidered
as entirely a tonic remedy. That or fome
other preparation of iron I have almoft
conftantly employed, though not indeed al-
ways with fuccefs. I have been perfuaded,
rhat the ens veneris of Mr Boyle, not-
withftanding his giving it this appellation,
was truly a preparation of iron, and no
other than what we now name the F lores
7 4 Mar-
3j2 PRACTICE
Martiales : but it appears, that both Bene-
voli and Buchner have employed a prepa-
ration of copper ; and I am ready to be-
lieve it to be a more powerful tonic than
the preparations of iron.
MDCCXXXI1.
Upon the fuppofition of tonic remedie:
being proper in this difeafe, I have endea-
voured to employ the Peruvian bark : but
from the difficulty of adminiftering it to
infants in any ufeful quantity, I have not
been able to difcover its efficacy; but I am
very ready to believe the teftimony of De
Haen upon this fubjed.
\
<
MDCCXXXIIL
Exercife, which is one of themoft power-
ful tonics, has been properly recommended
f ~ the cure of rickets ; and as the exer-
cife
v
OF PHYSIC. 3S3
cue of geftation only can be employed, it
fhould always be, with the child laid in a
horizontal fituation ; as the carrying them
or moving them in any degree of an ere6t
pofture, is very apt to occafion fome diftor-
tion. It is extremely probable, that, in
this difeafe, fri&ion with dry flannels may
be found an ufeful remedy.
MDCCXXXIV,
It is alfo fufficiently probable, that the
avoiding of moifture is not only advifable,
but may likewife be of fervice in the cure
of this difeafe.
There is no doubt that a certain diet
may contribute to the fame end ; but what
may be the moft eligible, I dare not deter-
mine. I have no doubt that leavened
bread may be more proper than unfer-
mented farinacea ; but I cannot find any
reafon to believe that ftrong beer can ever
be a proper remedy.
Prac-
3S4 PRACTICE
Practitioners have been divided in opi-
nion concerning the life of milk in this
difeafe. Zeviani, perhaps from theory,
condemns the ufe of it ; but Benevoli em-
ployed it without its impeding the cure of
the difeafe. This laft I have often remark-
ed in the courfe of my own practice. As it
is difficult to feed children entirely without
milk ; fo I have commonly admitted it as a
part of the diet of rickety children ; and in
many inftances I can affirm, that it did not
prevent the cure of the difeafe. In cafes,
however, of any appearance of rickets, and
particularly of a flow dentition, 1 have dif-
fuaded the continuance of a child upon the
breaft ; becaufe the milk of women is a more
watery nourifhment than that of cows : and
I have efpecially difluaded the continuing
a child upon the breaft, when I thought
the nurfe gave rather too much of fuch a
watery nourifhment ; for, as has been above
mentioned, I have had frequent occafion to
fufpedt
O F P H Y S I C. 355
fufpeft, th at the milk of fuch nurfes has a
tendency to favour the coming on of rickets.
MDCCXXXV.
Befides the remedies and regimen now
mentioned, practitioners have commonly
employed in this difeafe, both emetics and
purgatives. When the appetite and dige-
ftion are confiderably impaired, vomiting,
if neither violent nor frequently repeated,
feems to be of fervice ; and by a moderate
agitation of the abdominal vifcera, may
in fome meafure obviate the ftagnation
and confequent fwelling that ufually occur
in them*
As the tumid (late of the abdomen, fo
conftantly to be met with in this difeafe,
feems to depend very much upon a tym-
panitic affeftion of the inteftines; fo, both
by obviating this, and by deriving from
the abdominal vifcera, frequent gentle
3 PUI*ga~
3$6 PRACTICE
purgatives may be of fervice. Zeviani,
perhaps properly, recommends in parti-
cular rhubarb ; which, befides its purga-
tive quality, has thofe alfo of bitter and
aftringent.
MDCCXXXVL
I have now mentioned mod of the re-
medies commonly employed by the prac-
titioners of former times ; but I muft not
emit mentioning fome others that have
been lately fuggefted. The late Mr De
Haen recommends the teftacea; and affures
us of their having been employed with
fuccefs ; but in the few trials which I have
had occafion to make, their good effefts
did not appear.
The late Baron Van Swieten gives us
one inftance of rickets cured by the ufe
of hemlock ; but I do not know that the
pra&ice has been repeated.
ROOK
BOOK III.
OF THE
IMPETIGINIS;
O R
DEPRAVED HABIT, with AFFECTIONS
OF THE SKIN.
MDCCXXXVII.
I Find it difficult to give any fufficient-
ly correct and proper character of this
order. The difeafes comprehended un-
3 der
358 PRACTICE
der it, depend, for the moft part, upon a
depraved ftate of the whole of the fluids,
producing tumours, eruptions, or other
preternatural affedlions of the fkin. Al-
though it be extremely difficult to find a
general character of the order that will ap-
ply to each of the genera and fpecies, I
fliall here treat of the principal genera
which have been commonly comprehend-
ed under this order, and which I have
enumerated in my Nofology.
CHAP.
O F P H Y S I C. 359
CHAP. I.
Of Scrophula, or the King's Evir-.
T
MDCCXXXVIIL
H E character of this difeafe I have
attempted in my Nofology : but it
will be more properly taken from the
whole of its hiftory, now to be deliver-
ed.
MDCCXXXIX.
It is commonly, and very generally, a
hereditary difeafe j and although it fome-
times
360 PRACTICE
times may, yet it rarely appears, but in
children whofe parents had at fome pe-
riod of their lives been affected with it.
Whether it may not fail to appear in the
children of fcrophulous parents, and dif-
cover itfelf afterwards in their offspring in
the fucceeding generation, I cannot cer-
tainly determine; but believe that this has
frequently happened. It appears to me to
be derived more commonly from fathers
than from mothers ; but whether this
happens from there being more fcrophu-
lous men than fcrophulous women mar-
ried, I am not certain.
With refpedi to the influence of parents
in producing this difeafe, it deferves to be
remarked, that in a family of many chil-
dren, when one of the parents has been
affected with fcrophula, and the other not;
as it is ufual for fome of the children to
be in conftitution pretty exadlly like the
©ne parent, and others of them like the
other ;
O F P H Y S I C. 361
other ; ic commonly happens that thofe
children who mod refemble the fcrophu-
lous parent become allecled with fcrophu-
la, while thole refembling the other parent
entirely elcape. ^//~*
MDCCXL,
The fcrophula generally appears at a
particular period of life. It feldom appears
in the firit, or even in the fecond, year of
a child's life ; and mod commonly it oc-
curs from the fecond, or, as fome allege,
and perhaps more properly, from the third,
to the feventh year. Frequently, however^
it difcovers itfelf at a later period ; and
there are inftances of its firft appearance,
at every period till the age of puberty ;
after which, however, the firft appearance
of it is very rare.
Vol. IV. A a MDCCXLI.
$6i PRACTICE
MDCCXLI.
When it does not occur very early, we
can generally diftinguifh the habit of body
peculiarly difpofed to it. It moil com-
monly affecfls children of foft and flaccid
habits, of fair hair and blue eyes ; or at
leaft affedts thofe much more frequently
than thofe of an oppofice complexion. It
affedts efpecially children of fmooth fkins
and rofy cheeks ; and fuch children have
frequently a tumid upper lip, with a chop
in the middle of it ; and this tumour is
often confiderable, and extended to the
columna nafi. and lower part of the no-
ftrils. The difeafe is fometimes joined
with, or follows rickets ; and although it
frequently appears in children who have
not had rickets in any great degree, yet
it often attacks thofe who by a protube-
rant forehead, by tumid joints, and a tu-
mid abdomen, fliow that they had fome
ra-
i
O F P II Y S I C. 363
rachitic difpofition. In parents who, with-
out having had the difeafe thcmfelves,
iecm to produce fcrophulous children, we
can commonly perceive much of the fame
habit and conftitution that has been juft
now defer ibed;
Some authors have fuppofed that the
fmall-pox has a tendency to produce this
difeafe; and Mr DeHaen afTerts its follow-
ing the inoculated, more frequently than,
the natural, fmall-pox. This lad pofition,
however, we can confidently affirm to be a
miftake; although it muft be allowed, that
in fact the fcrophula does ofcen come on
immediately after the fmall-pox. It is,
however, difficult to find any connection
between the twTo difeafes. According to
my obfervation, the accident only happens
in children who have pretty manifeftly the
fcrophulous difpofition ; and 1 have had
feveral inftances of the natural fmall-pox
coming upon children affeded at the fame
A a 2 time
364 PRACTICE
time with fcrophula, not only without this
difeafe being any ways aggravated by the
fmall-pox, but even of its being for fome
time after much relieved.
MDCCXLII.
The fcrophula generally fliows itfelf firft
at a particular feafon of the year ; and at
fome time between the winter and fummer
folftice; but commonly long before the
latter period. It is to be obferved further,
that the courfe of the difeafe is ufually
connected with the courfe of the feafons,
Whilft the tumours and ulcerations pecu-
liar to this difeafe, appear firft in the
fpring, the ulcers are frequently healed up
in the courfe of the fucceeding fummer,
and do not break out again till the enfuing
fpring, to follow again with the feafon the
fame courfe as before,
MDCCXLIH.
OF PHYSI C. 36s
MDCCXLI1I.
Frequently the firfl: appearance of the
difeafe is the tumid and chopped lip above
mentioned. Upon other occafions the firft
appearance is that of fmall fpherical or oval
tumours, moveable under the fkin. They
are foft, but with fome elaflicity. They
are without pain ; and without any change
in the colour of the fkin. In this ftate
they often continue for a long time ; even
for a year or two, and fometimes longer.
Mod commonly they firft appear upon
the fides of the neck belowr the ears ; but
fometimes alfo under the chin. In either
cafe, they are fuppofed to affecft in thefe
places the conglobate or lymphatic glands
only ; and not at all the falivary glands,
till the difeafe is very greatly advanced.
The difeafe frequently affects, and even ar,
firfl appears in, other parts of the body.
In particular, it affe&s the joints of the el-
A a 3 bow:
J
66 PRACTICE
bows and ankles, or thofe of the fingers
and toes. The appearances about the joints
are not commonly, as elfewhere, fmall
moveable fwellings ; but a tumour almoft
uniformly furrounding the joint, and in-
terrupting its motion.
MDCCXL1V.
Thefe tumours, as I have faid, remain
for fome time little changed ; and, from
the time they firft appeared in the fpring,
they often continue in this way till the re-
turn of the fame feafon in the next, or
perhaps the fecond year after. About that
time, however, or perhaps in the courfe
of the feafon in which they firft appear,
the tumour becomes larger and more fix-
ed ; the flkin upon it acquires a purple,
feldom a clear rednefs: but growing red-
der by degrees, the tumour becomes foft-
sr, and allows the fluctuation of a liquid
within
OF PHYSIC. 367
within to be perceived. All this procefs,
however, takes place with very little pain
attending it. At length fome part of the
ikin becomes paler ; and by one or more
fmall apertures a liquid is poured out.
MDCCXLV.
The matter poured out has at nrft the
appearance of pus, but it is ufually of a
thinner kind than that from phlegmonic
abfcefTes ; and the matter as it continues
to be difcharged, becomes daily lefs puru-
lent, and appears more and more a vifcid
ferum, intermixed with fmall pieces of a
white fubftance refembling the curd of
milk. By degrees the tumour almoft en-
tirely fubfides, wThile the ulcer opens more,
and fpreads broader ; unequally, however,
in different directions, and therefore is
without any regular circumfcription. The
edges of the ulcer are commonly flat and
A a 4 fmooth,
368 PRACTICE
fmooth, both on their outfide and their
inner edge, which feldom puts on a callous
appearance. The ulcers, however, do not
generally fpread much, or become deeper;
but at the fame time their edges do not
advance, or put on any appearance of for-
ming a cicatrix.
MDCCXLVI.
In this condition the ulcers often conti-
nue for a long time; while new tumours,
with ulcers fucceeding them in the man-
ner above defcribed, make their appearance
in different parts of the body. Of the firft
ulcers, however, fome heal up, while other
tumours and ulcers appear in their vicinity,
or in other parts of the body: and in this
manner the difeafe proceeds, fome of the ul-
cers healing up, at leaft to a certain degree,
in the courfe of fummer, and breaking out
again in #ie fucceeding fpring: or it conti-
nues,
OF PHYSIC. 369
nues, by new tumours and ulcers fucceed-
ing them, in the fpring feafon, making their
appearance fucceilively for feveral years.
MDCCXLVII.
In this way the difeafe goes on for fe-
veral years ; bat very commonly in four
or five years it is fpontaneoufly cured, the
former ulcers being healed up, and no new
tumours appearing: and thus at length
the difeafe ceafes entirely, leaving only
fome indelible efchars, pale and fmooth,
but in fome parts fhrivelled; or, where
it had occupied the joints, leaving the
motion of thefe impaired, or entirely de-
ftroyed.
MDCCXLVII.
Such is the mod favourable courfe of
this difeafe; and with us, it is more fre-
quently
370 PRACTICE
quently fuch, than otherwife : but it is of-
ten a more violent, and fometimes a fatal
malady. In thefe cafes, more parts of the
body are at the fame time affected ; the
ulcers alfo feeming to be imbued with a
peculiarly {harp acrimony, and therefore
becoming more deep, eroding, fpreading,
as well as feldomer healing up. In fuch ca-
fes, the eyes are often particularly affedled.
The edges of the eye lids are affedted with
tumour and fuperficial ulcerations ; and
thefe commonly excite obflinate inflam-
mation in the adnata, which frequently
produces an opacity of the cornea.
When the fcrophula efpecially affecfls the
joints, it fometimes produces there confi-
derable tumours; in the abfcefles follow-
ing which, the ligaments and cartilages
are eroded, and the adjoining bones are
aflfefted with a caries of a peculiar kind.
In thefe cafes, alfo, of more violent fcro-
phula, while every year produces a num-
i ber
OF P II Y S I C. 371
ber of new tumours and ulcers, their acri-
mony feems at length to taint the whole
fluids of the body, occafioning a various
diforders ; and particularly a hectic fever,
with all its fymptoms, which at length
proves fatal, with fometimes the fymptoms
phthifis pulmonalis.
MDCCXL1X.
The bodies of perfons who have died of
this difeafe mow many of the vifcera in a
very morbid ftate ; and particularly mod
of the glands of the mefentery very much
tumefied, and frequently in an ulcerated
ftate. Commonly alfo a great number of
tubercles or cyfts, containing matter of
various kinds, appear in the lungs.
MDCCL
373
PRACTICE
MDCCL,
Such is the hiftory of the difeafe ; and
from thence it may appear, that the na-
ture of it is not eaiily to be afcertained. It
feems to be a peculiar affection of the
lymphatic fyftem ; and this in fome mea-
fure accounts for its connection with a
particular period of life. Probably, how-
ever, there is a peculiar acrimony of the
fluids that is the proximate caufe of the
difeafe ; although of what nature this is,
has not yet been difcovered. It may per-
haps be generally diffufed in the fyftem,
and exhaled into the feveral cavities and
cellular texture of the body; and there-
fore, being taken up by the abforbents,
may difcover itfelf efpecially in the lym-
phatic fyftem. This, however, will hardly
account for its being more confined to that
fyftem, than happens in the cafe of many o-
ther acrimonies which may be fuppofed to
be
OF PHYSIC. 373
be as generally diffufed. In fhort, its ap-
pearance in particular conftitutions, and at
a particular period of life, and even its be-
ing a hereditary difeafe, which fo fre-
quently depends upon the tranfmiflion of a
peculiar conftitution, are all of them cir-
cumftances which lead me to conclude, up-
on the whole,that this difeafe depends upon
a peculiar conflitution of the lymphatic f\fl em*
MDCCLI.
It feems proper to obferve here, that the
fcrophula does not appear to be a conta-
gious difeafe; at leaft I have known many
inftances of found children having had
frequent and clofe intercourfe with fcro-
phulous children without being infe&ed
with the difeafe. This certainly (hows,
that in this difeafe the peculiar acrimony
of it is not exhaled from the furface of the
body, but that it depends efpecially upon
a peculiar conflitution of the fyftem.
MDCCLIL
■7+ PRACTICE
MDCCLII.
Several authors have fuppofed the fcro-
phula to have been derived from the ve-
nereal difeafe; but upon no juft grounds
that I can perceive. In very many in (lan-
ces, there can hardly be any fufpicion of
the parents producing this difeafe having
been imbued with fiphylis, or with anyfi-
phylitic taint ; and I have known feveral
examples of parents conveying fiphylis to
their offspring, in whom, however, no
fcrophulous fymptoms at any time after-
wards appeared. Further, the fymptoms of
the two difeafes are very different; and the
difference of their natures appears parti-
cularly from hence, that while mercury
commonly and readily cures the fiphylis, it
does no fervice in fcrophula. and very of-
ten rather aggravates the difeafe.
MDCCLIIJ
OF PHYSIC. 375
MDCCLIII.
For the cure of fcrophula, we have not
yet learned any pratftice that is certainly
or even generally fuccefsful.
The remedy which feems to be the mod
fuccefsful, and which our practitioners e-
fpecially truft to and employ, is the ufe of
mineral waters f and indeed the warning*^ ■#***//*£
out, by means of thefe, the lymphatic fy-^ ■fcJE^,^
ftem, would feem to be a meafure promi-
fing fuccefs : but in very many inftances
of the ufe of thefe waters, I have not been
well fatisfied that they had fhortened the
duration of the difeafe more than had of-
ten happened when no fuch remedy had
been employed.
MDCCL1V.
With regard to the choice of the mine-
ral waters mod fit for the purpofe, I can-
not with any confidence give an opinion.
Almoft
.
'
,^«-£*?*^k*w C^ C,
376 PRACTICE
AJmoft all kinds of mineral waters,
whether chalybeate, fulphurious, or faline,
have been employed for the cure of fcro-
phula, and feemingly with equal fuccefs
and reputation : a circumftance which
leads me to think, that, if they are ever
fuccefsful, it is the elementary water that
is the chief part of the remedy.
Of late, fea- water has been efpecially re-
fcAtJtji 7 commended and employed ; but after nu-
merous trials, I cannot yet difcover its fu-
perior efficacy.
MDCCLV.
The other remedies propofed by pradli-
cal writers are very numerous ; but, upon
that very account, I apprehend they are little
to be trufted : and as I cannot perceive any
juft reafon for expedling fuccefs from
them, I have very feldom employed them.
Of late, the Peruvian bark has been
x much
Of PHYSIC,
377
much recommended : and as in fcrophu-
lous perfons there are generally iome marks
of laxity and flaccidicy, this tonic may
poflibly be of fervice ; but in a great va-
riety of trials, I have never feen it produce
any immediate cure of the difeafe.
In feveral inftances* the leaves jof colts- v^^'/**-
foot have appeared to me to be fuccefs- j£^ ^p^p jL
ful. I have ufed it frequently in a ftrong ^J^T^ '^ ^^
decodtion, and even then with advantage ; it u *Ja ^-
but have found more benefit from the*
exprefled juice, when the plant could be
had in fomewhat of a fucculent ftate,
foon after its firfk appearance in the
fpring.
MDCCLVI,
I have alfo frequently employed the hem-
lock, and have fometimes found it ufeful
in difcuffing obftinate fwellings : but in
this, it has alfo often difappointed me; and
Vol. IV. B b I
i
378 PRACTICE
I have not at any time obferved that it
difpofed fcrophulous ulcers to heal.
I cannot conclude the fubjedl of inter-
nal medicines without remarking, that I
have never found, either mercury or anti-
mony, in any fhape, of ufe in this difeafe ;
and when any degree of a feverifh ftate
had come on, the ufe of mercury proved
manifeftly hurtful,
MDCCLVII.
In the progrefs of fcrophula, feveral
external medicines are requifite. Several
applications have been ufed for difcuffing
the tumours upon their firft coming on ;
but hitherto my own practice, in thefe
refpefts, has been attended with very
little fuccefs. The folution of faccharum
faturni has feemed to be ufeful ; but
it has more frequently failed : and I
have had no better- fuccefs with the fpi-
ritus
OF PHYSIC, 379
htus Mindereri. Fomentations of every
kind have been frequently found to do
harm ; and poultices feem only co hurry on
a fuppuration. I am doubtful if this laft
be ever praclifed with advantage; for fcro-
phulous tumours fometimes fpontaneoufly
difappear, but never after any degree of
inflammation has come upon them ; and
therefore poultices, which commonly in-
duce inflammation, prevent that difcuf-
fion of tumours, which might otherwifc
have happened.
Even when fcrophulous tumours have
advanced towards fuppurationj I am un-
willing to haften the ipontaneous opening,
or to make it by the lancet ; becaufe I ap-
prehend the fcrophulous matter is liable to
be rendered more acrid by communication
with the air, arid to become more eroding
and fpreading than when in its inclofed
ftate.
fe b 2 MDCCLViii,
380 PRACTICE
MDCCLVIII.
The management of fcrophulous ulcers
has, fo far as I know, been as little fuc-
cefsful as that of the tumours. Efcha-
rotic preparations, of either mercury or
copper, have been fometimes ufeful in
bringing on a proper fuppuration, and
thereby difpofing the ulcer to heal ; but
they have feldom fucceeded, and more
commonly they have caufed the ulcer to
fpread more. The cfcharotic from which
fL. fr*S«K„u~z\ have received mod benefit is burnt alum;
i&r>^^^ and a portion of that mixed with a mild
ointment, has been as ufeful an application
as any I have tried. The application, how-
ever, that 1 have found mod ferviceabk,
and very univerfally admiflible, is that of
linen cloths wetted with cold water, and
frequently changed when they are becoming
dry, it being inconvenient to let them be
glued to the fore. They are therefore to
be
V
OF PHYSIC. 381
be changed frequently during the day; and
a cloth fpread with a mild ointment or
plafter may be applied for the night. In
this pradice I have fometimes employed /c^ Ls^L^ 1.
fea-water : but generally it proved too ir-y^~ ^TrftL
ritating ; and neither that nor any minc-^**-*'—
ral water has appeared to be of more fer-
vice than common water.
MDCCLIX.
To conclude what I have to offer upon
the cure of fcrophula, I mud obferve, that
cold bathing feems to have been of more
benefit than any other remedy that I have
had occafion to fee employed.
Bb3 CHAP.
i
38? PRACTICE
CHAP. II.
Or SiphyliSjOR theVewereal DlSEA?*
A
MDCCLX.
F T E R practitioners have had fo
much experience in treating this dif-
eafe, and after fo many books have been
publifhed upon thefubjeft, it does not feem
- T" ^7 neceflary, oreveq proper, for me to attempt
'ftz.CJG^»Cnp any full treatife concerning it ; and I fliall
^y therefore confine myfelf to fuch general
remarks, as may ferve to illuftrate fome
parts of the pathology or of the pracflice.
MDCCLXL
OF P H Y 8 I C. 383
MDCCLXL
It is fufficiently probable, that, ancient-
ly, in certain parts of Afia, where the
leprofy prevailed, and in Europe after
M that difeafe had been introduced into it, a
difeafe of the genitals, refembling that
which now commonly arifes from fiphy-
lis, had frequently appeared : but it is
equally probable, that a new difeafe, and
what we at prefent term Siphylis, was firffc
brought into Europe about the end of the
fifteenth century ; and that the diftemper
now fo frequently occurring, has been
very entirely derived from that which was
imported from America at the period men-
tioned.
MDCCLXII.
This difeafe, at lead in its principal
circumftances, never arifes in any perfon
B b 4 but
384 PRACTICE
but from fome communication with a
perfon already affedted with it. It is mod
commonly contracted in confequence of
coition with an infedted perfon ; but in
what manner the infection is communi-
cated, is not clearly explained. I am per^- #)
fuaded, that in coition, it is communicated
without there being any open ulcer either
in the perfon communicating or in the per-
fon receiving the infedlion; but in all other
cafes, I believe it is never communicated in
any other way than by a contadt of ulcer,
either in the perfon communicating or in
the perfon receiving the infedtiom
MDCCLXIH.
As it thus arifes from the contact of par-
ticular parts, fo it always appears firft in
the neighbourhood of the pares to which
the infedting matter had been immediately
applied 3 and therefore, as jrtoft common-
Iv
O F P II Y S I ( ! 3*
ly contracted by coition, it generally ap*
pears fir It in the genitals.
MDCCLXIV.
• After its firft appearance in particular
parts, more efpecially when thefe are the
genitals of either fex, its effects for fome time -
feem to be confined to thefepafts; and in-
deed, in many cafes, never extends further.
In other cafes, however, the infecting mat-
ter pafles from 'the parts firft affecfted, and
from the genitals therefore, into the blood -
veffels ; and being there difFufed, produces
diforders in many other parts of the body.
From this view of the circumftances,
phyficians have very properly diftinguifhed
the different dates of the difeafe, according
as they are local or are more univerfal. To
the former, they have adapted appella-
tions fuited to the manner in which the
difeafe appears ; and to the other the gene-
ra!
386
PRACTICE
ral aflfedtion, they have almoft totally con-
fined the appellations of Siphylis, Lues Ve-
nerea, or Pgx. In the remarks I am now
to offer, I fhall begin with confidering the
local affe&ion.
MDCCLXV.
This local affe<£lion appears chiefly ii
the form of gonorrhoea or chancre.
The phenomena of gonorrhoea either up-
on its firft coming on or in its after progrefs,
or the fymptoms of ardor urinae, chordee,
or others attending it, it is not neceiTary
for me to defcribe. I fhall only here ob-
ferve, that the chief circumftance to be ta-
ken notice of, is the inflamed ftate of the
urethra, which I take to be infeparable
from the difeafe.
MDCCLXVI.
o f p ii y s i a
MDCCLXVI.
In thefe well-known circumftances, the
gonorrhoea continues for a time longer or
ihorter, according to the conftitution of the
patient; it ufually remaining longeft in the
mod vigorous and robuft, or according to
the patient's regimen, and the care taken to
relieve or cure the difeafe. In many cafes,
if by a proper regimen the irritation of
the inflamed ftate is carefully avoided, the
gonorrhoea fpontaneoufly ceafes, the fymp-
toms of inflammation gradually abating,
the matter difcharged becoming of a thick-
er and more vifcid confidence, as well as
of a whiter colour ; till at length, the flow
of it ceafes altogether ; and whether it be
thus cured fpontaneoufly, or by art, the
difeafe often exifts without communica-
ting any infedtion to the other parts of
the body.
MDCCLXVU.
388 PRACTICE
MDCCLXVII.
Inother cafes, however, thedifeafe having
been negledted, or by an improper regimen
aggravated, it continues with all its fymp-
toms for a long time ; and produces va-
rious other diforders in the genital parts,
which, as commonly taken notice of by
authors, need not be defcribed here. I
fhall only obferve, that the inflammation
of the urethra, which at firft feems to be
feated chiefly, or only, in its anterior
parts, is in fuch negledled and aggra-
vated cafes fpread upwards along the ure-
thra, even to the neck of the bladder.
In thefe circumftances, a more confiderable
inflammation is occalioned in certain parts
of the urethra; and confequently, fup-
puration and ulcer are produced, by which
the venereal poifon is fometimes commu-
nicated to the fyftem, and gi^es rife to a
general fiphylis.
MDCCLXVIII.
O F P H Y S I C. 389
MDCCLXV1II.
It was fome time ago a pretty general
fuppofition, that the gonorrhoea depended
always upon ulcers of the urethra, pro-
ducing a di (charge of purulent matter; and
fuch ulcers do indeed fometimes occur in
the manner that has been juft now men-
tioned. We are now allured, however, from
many difTedtions of perfons who had died
when labouring under a gonorrhoea, that
the difeafe may exift, and from many con-
futations it is probable that it commonly
does exift, without any ulceration of the
urethra ; fo that the difcharge which ap-
pears, is entirely that of a vitiated mucus
from the mucous follicles of the urethra.
MDCCLX1X.
Although moft of the fymptoms of go-
norrhoea fhould be removed, yet it often
happens
39o PRACTICE
happens that a mucous fluid continues to
be difcharged from the urethra for a long
time after, and fometimes for a great pare
of a perfon's life. This difcharge is what
is commonly called a Gleet.
With refpedt to this, it is proper to ob-
ferve, that in fome cafes, when it is certain
that the matter difcharged contains no ve-
nereal poifon, the matter may, and often
does, put on that puriform appearance, and
that yellow and greenifti colour, which ap-
pears in the difcharge at the beginning and
during the courfe of a virulent gonorrhoea.
Thefe appearances in the matter of a gleet,
which before had been of a lefs coloured
kind, have frequently given occafion to
fuppofe that a frefh infedion had been
received : but 1 am certain that fuch ap-
pearances may be brought on by, per-
haps, various other caufes ; and particu-
larly, by intemperance in venery and
drinking concurring together. I believe,
y indeed,
OF PHYSIC. 391
indeed, that this feldom happens to any
but thofe who had before frequently la-
boured under a virulent gonorrhoea, and
have more or lefs of gleet remaining with
them : but I muft alfo obferve, that in per-
fons who at no period of their life had ever
laboured under a virulent gonorrhoea, or
any other fymptom of fiphylitic affedtion,
I have met with inftances of difcharges
from the urethra refembling thofe of a vi-
rulent gonnorhoea.
The purpofe of thefe obfervations is, to
fugged to practitioners what I have not
found them always aware of, that in per-
fons labouring under a gleet, fuch a re-
turn of the appearances of a virulent go-
norrhoea may happen without any new
infection having been received, and confe-
quently not requiring the treatment which
a new infedtion might perhaps demand.
When in the cure of gonorrhoea it was the
practice to employ purgatives very fre-
- • * quently,
\
L
/
/
392 PRACTlCt
quently, and fomctimes thofe of the draflic
kind, I have known the gleet, or fpurious
gonorrhoea, by fuch a practice much in-
creafed,. and long continued, and the pa-
tient's conftitution very much hurt. Nay,
in order more certainly further to prevent
miftakes, it is to be obferved, that the fpu-
rious gonorrhoea is fometimes attended
with heat of urine, and fome degree of
inflammation; but thefe fymptoms are
feldom confiderable, and, merely by the
afliftance of a cool regimen, commonly
difappear in a few days.
MDCCLXX.
With refpedt to the cure of a virulent
gonorrhoea, I have only to remark, that
if it be true, as I have mentioned above,
that the difeafe will often, under a pro-
per regimen, be fpontaneoufly cured; and
that the whole of the virulent matter
may be thus entirely difcharged without
l the
& 1
OF PHYSIC. 393
the affiftancc of art ; it would fcem that
there is nothing required of practitioners,
but to moderate and remove that inflam-
mation which continues the difeafe, and
occaiions all the troublefome fymptoms
that ever attend it. The fole bufinefs
therefore of our art in the cure of gonor-
rhoea, is to take off the inflammation ac-
companying it; and this I think may com-
monly be done, by avoiding exercife, by
ufing a low and cool diet, by abstaining
entirely from fermented and fpirituous li- ^ „
quors, and by taking plentifully of mild ; #^ , ^ *>&c4
diluent drinks* tVT^T **
MDCCLXXI.
The heat df urine, which is fo trouble-
fome in this difeafe, as it arifes from the
increafed fenfibility of the urethra in its in-
flamed (late; fo, on the other hand, the ir-
ritation of the urine has the effedl of in-
Vol. IV, C c creafing
/>^<U£
394 PRACTICE
creafing the inflammation, and is there*
fore to be removed as foon as poflible.
This can be done moft effectually by ta-
king in a large quantity of mild watery li-
^<^^^quors- Demulcents may be employed;
*~^~ ^^^— but unlefs they be accompanied with a
JljMtey <~r>y large quantity of water, they will have
j ' little effeft. Nitre has been commonly em-
toJz, *A~~- ^-—ployed as a fuppofed refrigerant: but,
V from much obfervation, I am convinced,
that in a fmall quantity it is ufelefs, and
in a large quantity certainly hurtful ; and,
for this reafon, that every faline matter
pafling with the urine generally gives fome
irritation to the urethra. To prevent the
irritation of the urethra arifing from its
increafed fenfibility, the injection of muci-
lage or of mild oil into it has been pradli-
fed; but 1 have feldom found this of much
fcrvice.
MDCCLXXII.
■
OF PHYSIC. 39s '
MDCCLXXII.
In gonorrhoea, as coftivenefs may be
hurtful, both by an irritation of thefyftem
in general, and of the urethra in particular,
as this is occafioned always by the void-
ing of hardened fasces ; fo coftivenefs is to
be carefully avoided or removed; and the
frequent ufe of large glyfters of water and
oil, I have found of remarkable benefit in
this difeafe. If glyfters, however, do not
entirely obviate coftivenefs, it will be ne-
ceflary to give laxatives by the mouth :
which, however, fhould be of the mildeft
kind, and fhould do no more than keep the
belly regular and a little loofe, without
much purging.
The pradlice of frequent purging, which ^O / tz *->** ftz
was formerly fo much in ufe, and is notCLal. /
yet entirely laid afide* has always appear-
ed to me to be generally fuperfluous, and
often very hurtful. Even what are fup-
C c i pofed
396 PRACTICE
pofed to be cooling purgatives, fuch as
Glauber's fait, foluble tartar, and cry-
stals of tartar, in fo far as any part of
them pafs by urine, they, in the fame
manner as we have faid of nitre, may be
hurtful ; and fo far as they produce very
liquid ftools, the matter of which is gene-
rally acrid, they irritate the redtum, and
confequently the urethra. This laft ef-
fect, however, the acrid, and in any de-
gree draftic, purgatives, more certainly pro-
duce.
MDCCLXXIII.
In cafes of a gonorrhoea attended with
violent inflammation, blood-letting may
be of fervice; and in the cafe of perfons
of a robuft and vigorous habic, in whom
the difeafe is commonly the mod violent,
blood-letting may be very properly em-
ployed, As general bleedings, however,
when
,
O F P II Y S I C. 397
when there is no phlogiftic diathefis in the
fyftem, have littie eflcCt in removing topi-
cal inflammation; fo in gonorrhoea, when
the inflammation is confiderable, topical
bleeding applied to the urethra by leeches,
is generally more effectual in relieving the
inflammation.
iMDCCLXXlV.
When there is any phymofis attending a
gonorrhoea, emollient fomentations applied
to the whole penis are often of fervice. In
fuch cafes it is necefTary, and in all others
ufeful, to keep the penis laid up to the bel-
ly, when the patient either walks about or
is fitting.
MDCCLXXV.
Upon occasion of frequent priapifm and
chordee, it. has been found ufeful to ap-
C c 3 ply
398 PRACTICE
ply to the whole of the penis a poultice of
crumb of bread moiftened with a ftrong
folution of fugar of lead. I have, how-
ever, been often difappointed in this prac-
tice, perhaps by the poultice keeping the
penis too warm, and thereby exciting the
very fymptomsl wifhed to prevent. Whe-
ther lotions of the external urethra with
a folution of the fugar of lead, might
be ufeful in this cafe, I have not properly
tried.
MDCCLXXVL
With refpeft to the ufe of inje&ions, f o
frequently employed in gonorrhoea, I am
perfuaded, that the early ufe of aftringent
injedions is pernicious ; not by occafion-
ing a fiphylis, as has been commonly ima-
gined; but by increafing and giving occa-
fion to all the confequences of the inflam-
mation, particularly to the very trouble-
fome
OF PHYSIC. 399
fome fymptoms of {Veiled teflicles. When,
however, thedifeafe has continued for fome
time, and the inflammatory fymptoms
have very much abated, I am of opinion,
that by inje&ions of moderate aftringency, &* /*^£~u.A6*+^
or at lealt of this gradually increafed, an ^ *
end may be fooner put to the difeafe than
would otherwife have happened ; and that
a gleet, fo readily occurring, may be gene-
rally prevented,
MDCCLXXVII.
Befides the ufe of aftringent inje&ions,
it has been common enough to employ
thofe of a mercurial kind. With refpedl
to thefe, although I am convinced that the
infecftion producing gonorrhoea, and that
producing chancres and fiphylis, are one
and the fame ; yet I apprehend, that in go-
norrhoea mercury cannot be of ufe by cor-
reeling the virulence of the infection ; and
C c 4 there-
4oo PRACTICE
therefore that it is not univerfally necef-
fary in this difeafe. 1 am perfuaded, how-
ever, that mercury applied to the internal
furface of the urethra, may be of ufe in
promoting the more full and free dis-
charge of virulent matter from the mu-
cous glands of it. Upon this fuppofition,
I have frequently employed mercurial in-
jections ; and, as I judge, with advantage;
thofe injections often bringing on fuch a
ftate of the confidence and colour of the
matter difcharged, as we know ufually to
precede its Spontaneous ceafing. I avoid
thefe injections, however, in recent ca-
fes, or while much inflammation is ftill
prefent ; but when that inflammation has
fbmewhat abated, and the difcharge not-
withftanding ftill continues in a virulent
form, I employ mercurial injections free-
ly. I employ thofe only that contain
mercury entirely in a liquid form, and a-
vcid thofe which may depofite an acrid
powder
O F PHYSIC. 4ot
powder in the urethra. That which Ij/*^,^ ~
have round moil ufeful is a folution of the ^"T.
corrohve fublimatc in water ; lo much di- *//
luted as not to occaiion any violent fmart- /^**— ^ **■
ing, but not fo much diluted as to give no^^^ £ ~— <^~
fmarting at all. It is fcarce neceflfary to i*^~*
add, that when there is reafon to fufpeft
there are ulcerations already formed in the
urethra, mercurial injections are not only
proper, but the only effectual remedy tha^
can be employed.
MDCCLXXVIII.
With regard to the cure of gonorrhoea, I
have only one other remark to offer. As
mod of the fymptoms ariie from the irri-
tation of a (limulus applied, the effects of
this irritation may be often leffened by di-
rninifliing the irritability of the fyftem;
and it is well known, that the mod certaiu
ipeans of accomplifhing this is by employ-
ing
402 PRACTICE
ing opium. For that reafon, I confider the
practice both of applying opium directly
to the urethra, and of exhibiting it by the
mouth, to be extremely ufeful in mod ca-
fes of gonorrhoeae
MDCCLXXIX.
After thus offering fome remarks with
refpect to gonorrhoea in general, 1 might
proceed to confider particularly the vari-
ous fymptoms which fo frequently attend
it; but it does not feem neceffary for
me to attempt this after the late publica-
tions of Dr Foart Simmons, and of Dr
Schwediauer, who have treated the fubjedl
fo fully, and with fo much difcernment
and (kill.
MDCCLXXX.
The other form of the local affection of
fipfrylis,
O F P H Y S I C. 403
fiphylis, is that of chancre. The ordinary
appearance of this I need not defcribe, it
having been already To often done. Of
the few remarks 1 have to offer, the firft is,
that I believe chancres never appear in any
degree without immediately communica-
ting to the blood more or lefs of the vene-
real poifon: for I have conftantly, when-
ever chancres had appeared, found, that
unlefs mercury was immediately given in-
ternally, fome fymptoms of a general fi-
phylis did certainly come on afterwards;
and though the internal ufe of mercury
fhould prevent any fuch appearance, it is
(till to be prefumed that the poifon had
been communicated, becaufe mercury could
a& upon it in no other manner than as
diffufed in the fluids.
MDCCLXXXI.
It has been a queftion among pracYi?-
tioners,
404 PRACTICE
tioners, upon the fubjedl of chancres, Whe-
ther they may be immediately healed up
by applications made to the chancres, or
if they fhould be left open for fome time
without any fuch application ? It has been
fuppofed, that the fudden healing up of
chancres might immediately force into the
blood a poifon, which might have been
excluded by being difcharged from the
chancre. This, however, is a fuppofition
that is very doubtful ; and, upon the other
hand, I am certain, that the longer a chancre
is kept open, the more poifon it perhaps
generates, and certainly fupplies it more
copioufly to the blood, And although the
above* mentioned fuppofition were true, it
will be of little confequence, if the internal
tife of mercury, which I judge necefTary
in every cafe of chancre, be immediately
employed. I have often feen very trouble-
fome confequences follow from allowing
chancres to remain unhealed ; and the
fymp-
i.
O F P H Y S I C. 405
fympcoms of general fiphylis have always
feemed to me to be more confiderable and
violent in proportion as chancres had been
fuffered to remain longer unhealed. They
fhould always, therefore, be healed as foon
as pofllble ; and that, by the only very ef-
fectual means, the application of mercu-
rials to the chancre itfelf. Thofe that are
recent, and have not yet formed any con-
fiderable ulcer, may often be healed by
the common mercurial ointment; but the
mod powerful means of healing them has
appeared to me, to be the application of
red precipitate in a dry powder.
MDCCLXXXII.
When, in confequence of chancres, or
of the other circumftances above men-
tioned, by which it may happen the ve-
nereal poifon has been communicated to
the blood, it produces many different
fymp-
4o6 PRACTICE
fymptoms in different parts of the body?
not neceffary to be enumerated and de*
fcribed here, that having been already
done by many authors with great accu-
racy.
MDCCLXXXIII.
Whenever any of thofe fymptoms do
in any degree appear, or as foon as it is
known that the circumftances which give
occafion to the communication of the ve-
nereal poifon have taken place, I hold the
internal ufe of mercury to be immediately
neceffary ; and I am well perfuaded, that
mercury employed without delay, and in
fufficient quantity, will pretty certainly
prevent the fymptoms which would other-
wife have foon appeared, or will remove
thofe that may have already difcovered
themfelves. In both cafes, it will fecure
the
OF PHYSIC. 407
the perfon from any future confequencea
of fiphylis from that iiifeftion.
MDCCLXXXIV.
This advice for the early and full ufe of
mercury, I take to be the mod important
that can be given with refpedt to the ve-
nereal difeafe : And although I muft admit
that the virulence of the poifon may be
greater in one cafe than in another, and
even that one conftitution may be more
favourable than another to the violence of
the difeafe ; yet I am thoroughly convin-
ced, that mod of the inftances which have
occurred of the violence and obftinacy of
fiphylis have been owing very entirely to the
negleft of the early application of mercury,
MDCCLXXXV.
Whatever other remedies of fiphylis may
be
4o8 PRACTICE
be known, or may hereafter be found out,
I cannot pretend to determine ; but I am
well perfuaded, that in mod cafes mer-
cury properly employed will prove a very
certain and effectual remedy. With re-*
fpedt to others that have been propofed*
I ftiall offer this remark only, that I
have found the decocftion of the mezereon
contribute to the healing of ulcers which
feemed to have refilled the power of mer-
cury.
MDCCLXXXVI.
With regard to the many and various
preparations of mercury, I do not think
it necefTary to give any enumeration of
them here, as they are commonly very
well known, and have been lately well
enumerated by Dr Schwediauer. The
choice of them feems to be for the mod
part a matter of indifference ; as I believe
cures
OF PHYSIC. 409
Cures have been, and ftill may be, effected
by many different preparations, if properly
adminiftered. The proper adminiftration
feenis to confift, iy?, In the choofing thofe
preparations which are the lead ready to
run off by ftool ; and therefore the appli-
cations externally by un&ion, are in many
safes the mod conveniens 2<Jh, In em-
ploying the unction, or in giving a pre-
paration of mercury internally, in fuch
quantity as may mow its fenfible effedts
in the mouth. And, yil)\ without carry-
ing thefe effe&s to a greater length, In the
continuing the employment of mercury for
feveral weeks, or till the fymptoms of the
difeafe (hall have for fome time entirely
difappeared. I fay nothing of the regi-
men proper and necefTary for patients du-
ring the employment of mercury, becaufe
I prefume it 10 be very well known.
Vol. IV. D d MDCCLXXXVII.
4io. PRACTICE
MDCCLXXXVII.
Amongft the other preparations of mer-
cury, I believe the corrofive fublimate ha9
often been employed with advantage : but
I believe alfo, that it requires being con-
tinued for a longer time than is neceflary
in the employment of other preparations
in the manner above propofed ; and I fuf-
pe£t it has often failed in' making a cure,
becaufe employed while perfons were at the
fame time expofed to the free air.
MDCCLXXXVIII.
Upon thefe points, and others relative
to the adminiftration of mercury, and the
cure of this difeafe, I might offer fome par-
ticular remarks : but I believe they are ge-
nerally underftood ; and it is enough for
me to fay here, that if practitioners will
attend, and patients will fubmit, to the
general
OF PHYSIC. 411
general rules given above, they will fel-
dom fail of obtaining a certain and fpeedy
<:ure of the difeafe.
D d 2 CHAP,
4i2 PRACTICE
CHAP. HI.
Of SCURVY.
MDCCLXXXIX.
THIS difeafe appears fo frequently,,
and the effects of it are fo often fa-
tal, in fleets and armies, that it has very
properly engaged the particular attention
of phyficians. It is indeed furprifing that
it had not fooner attracted the efpecial no-
tice both of ftatefmen and phyficians, fo
as to have produced thofe meafures and
regulations that might prevent the havock
which
O F P II Y S I C. 413
which it fo often occafions. Within thefe
laft fifty years, however, it has been fo
much attended to and ftudied, that we
might fuppofe every circumftance relating
to it fo fully and exadtly afcertained, as to
render all further labour upon the fub-
jeft fuperfluous. This perhaps may be
true; but it appears to me, that there are
ftill feveral circumftances regarding the
difeafe not agreed upon among phyficians,
as well as different opinions formed, fome
of which may have a bad effect upon the
practice: and this feems to me to be fo much
the cafe, that I hope I (hall be excufed in
endeavouring here to ftate the fadls as they
appear to me from the bed authorities, and
to offer remarks upon opinions which may
influence the pra&ice in the prevention and
cure of this difeafe.
D d 3 MDCCXC.
4X4 PRACTICE
MDCCXC.
With refpecfl to the phenomena of the
difeafe, they have now been fo fully ob-
ferved, and fo accurately defcribed, that
there is no longer any doubt in difcerning
the difeafe when it is prefent, or in di-
ftinguifliing it from almoft every other
ailment. In particular, it feems now to be
fully determined, that there is one difeafe
only, intitled to the appellation of Scurvy ;
that it is the fame upon the land as upon
the fea ; that it is the fame in all climates
and feafons, as depending every where up-
on nearly the fame caufes ; and that it is
not at all diverlified, either in its pheno-
mena or its caufes, as had been imagined
fome time ago.
MDCCXCT.
The phenomena of fcurvy, therefore,
are
OF PHYSIC. 415
are not to be defcribed here, as it has been
fo fully and accurately done e 1 few here ;
and I fhall only endeavour to afcertain
thofe facfls with refpedl to the preven-
tion and cure of the difeafe which feem
not yet to be exadly agreed upon. And,
firll, with refpecft to the antecedents that
may be confidered as the remote caufes of
the difeafe.
MDCCXCII.
The mod remarkable circumftance a-
mongft the antecedents of this difeafe is,
that it has mod commonly happened to
men living very much on faked meats ;
and whether it ever arife in any other
circumftances, is extremely doubtful.
Thefe meats are often in a putrefcent
ftate ; and to the circumftance of the long
continued ufe of animal food in a putref-
cent and fomewhat indigeftible ftate, the
D d 4 dif-
4i6 PRACTICE
difeafe has been efpecially attributed. Whe-
ther the circumftance of the meat's being
faked, has any effed in producing the dif-
eafe, otherwife than by being rendered
more indigeftible, is a queftion that re-
mains ftill in difpute.
MDCCXCIII.
It feems to me, that the fait concurs in
producing the effed ; for there is hardly
any inftance of the difeafe appearing unlefs
where faked meats had been employed, and
Scarcely an example where the long conti-
nued ufe of thefe did not produce it: befides
all which, there are fome inftances where,
by avoiding faked meats, or bydiminilhing
the proportion of them in diet, while other
circumftances remained much the fame,
the difeafe was prevented from appearing,
further, if it may be admitted as an argu-
ment upon this fubjed, 1 fhall hereafter en-
deavour
0 I V II Y S I C. 4iy
OOf to fliow, that the large ufe of fait
has a tendency to aggravate and incveafe
the proximate caufe of lcurvy.
MDCCXCLV.
It mutt however be allowed, that the
principal circumftance in caufing fcurvy,
is the living very much and very long upon
animal food,efpecially when in a putrefcent
ftate ; and the clear proof of this is, that a
quantity of freih vegetable food will always
certainly prevent the difeafe.
MDCCXCV.
While it has been held, that, in thofe
circumflances in which fcurvy is produ-
ced, the animal food employed was efpe-
cially hurtful by its being of difficult di-
geftion, this opinion has been attempted to
be confirmed, by obferving, that the reft of
the
4i8 PRACTICE
the food employed in the famccircumftan-
ces was alfo of difficult digeftion. This is
fuppofed to be efpecially the cafe of unfeiv
mented farinacea which fo commonly makes
a part of the fea-diet. But I apprehend this
opinion to be very ill-founded ; for the un-
fermented farinacea, which are in a great
proportion the food of infants, of women,
and of the greater part of mankind, can
hardly be fuppofed to be food of difficult
digeftion : and with refpecl to the produc-
tion of fcurvy, there are fads which (how,
that unfermented farinacea, employed in
large proportion, have had a confiderable
efFedt in preventing the difeafe.
MDCCXCVI.
It has been imagined, that a certain im-
pregnation of the air upon the fea had an
effedl in producing fcurvy. But it is al-
together improbable : for the only im-
preg-
OF PHYSIC. 419
pregnations which could be fufpecled, are
thofe of inflammable or mephitic air; and
it is now well known, that thefe impreg-
nations are much left in the air upon the
fea than in that upon the land ; befides,
there are otherwife many proofs of the fa-
lubricy of the fea-air. If, therefore, fea-
air have any effect in producing fcurvy,
it muft be by its fenfible qualities of cold
or moifture.
MDCCXCVII.
That cold has an effect in favouring the
production of fcurvy, is manifeft: from
hence, that the difeafe is more frequent
and more confiderable in cold than in
warm climates and feafons ; and that even
warm cloathing has a confiderable effect
in preventing it.
MDCCXCVHL
4*o PRACTICE
MDCCXCVIII.
Moifture may in general have an effe£i
in favouring the production of fcurvy,
where that of the atmofphere in which
men are placed is very confiderable : but
the ordinary moifture of the fea-air is far
from being fuch. Probably it is never
confiderable, except in the cafe of unufual
rains ; and even then it is perhaps by
the application of moifture to the bodies
of men in damp cloathing only that it
has any {hare in the production of fcurvy.
At the fame time, I believe there is no
inftance of either cold or moifture pro-
ducing fcurvy, without the concurrence of
the faulty fea diet.
MDCCXCIX.
Under thofe circumftances which pro-
duce fcurvy, it commonly feems to occur
inoft readily in the perfons who are the
lead
OF PHYSIC. 421
leaft exercifcd; and it is therefore probable,
that confinement and want of excrcife may
have a great fhare in producing the dif-
eafe.
MDCCC.
It appears that weaknefs, in whatever
manner occafioned, 19 favourable to the
production of fcurvy. It is therefore pro-
bable, that unufual labour and fatigue
may often have fome fhare in bringing ic
on: and upon the fame account, it is pro-
bable, that fadnefs and defpondency may
induce a weaknefs of the circulation ; and
be thereby, as has been remarked, favour-
able to the produ&ion of fcurvy.
MDCCCL
It has alfo been obferved, that perfons
negligent in keeping their fkin clean by
warning and change of cloathing, are more
liable
422 PRACTICE
liable than others to be affeded with
fcurvy,
MDCCCIL
Several of thefe caufes* now mentioned,
concurring together, feem to produce
fcurvy ; but there is no proper evidence
that any one of them alone will produce it,
or that all the others uniting together will
do it, without the particular concurrence
of the fea diet. Alongft with this, how-
ever, feveral of the other circumftances
mentioned, have a great efFedl in produ-
cing it fooner, and in a more confiderable
degree, than would otherwife have hap-
pened from the diet alone.
MDCCCIII.
From this view of the remote caufes,
it will readily appear, that the preven-
tion
j
OF PHYSIC 423
tion of the difeafe may in fome meafure
depend upon the avoiding of thofe cir-
cumftances which we have enumerated as
contributing to bring on the difeafe fooner
than it would otherwife come on. At the
fame time, the only effectual means will be,
by avoiding the diet of faked meats ; at
lead by leffening the proportion of thefe,
and ufing meat preferved otherwife than
by fait ; by ufing in diet any kind of efcu-
lent vegetable matter that can be obtain-
ed; and efpecially by ufing vegetable mat-
ters the moft difpofed to acefcency, fuch
as malt ; and by drinking a large quan-
tity of pure water.
MDCCCIV.
The cure of. fcurvy feems now to be
very well afcertained ; and when the ne-
ceflary means can be obtained, the difeafe
is commonly removed very quickly. The
3 chief
*r
^
*
424 PRACTICE
chief means it a food of frefii and fuccu-
lent vegetables, and thofe aknoft of any
kind that are at all efculent. Thofe molt
immediately effectual are the acid fruits,
and, as being of the fame nature, all fort
of fermented liquor.
DCCCV.
The plants named alkalefcent, fuch as
thofe of the garlic tribe and of the tetratfy-
namise, are alfo particularly ufeful in the!
cure of this difeafe ; for, notwithstanding
their appellation, they in the firft partof
their fermentation undergo an acefcency,
and feem to contain a great deal of ace-
fcent matter. At the fame time, they have
generally in their compoiuion an acrid
matter that readily pafFes by urine, proba-
bly by perfpiration ; and, by promoting
both excretions, afe ufeful in the difeafe.
It is probable, that fome plants of the co-
4 niferous
b*
OF PHYSIC. 425
niferous tribe, fuch as the fpruce fir, and
others poflefled of a diuretic power, may
likewifc be of fome ufe.
MDCCCVI.
It is fufficiently probable, that milk of
every kind, and particularly its produc-
tions whey and butter- milk, may prove a
cure of this difeafe.
MDCCCVIL
It has been common in this difeafe to
employ the foflil acids ; but there is reafon
to doubt if they be of any fervice, and it
is certain they are not effectual remedies.
They can hardly be thrown in, in fuch
quantity as to be ufeful antifeptics; and as
they do not feem to enter into the compo-
fition of the animal fluids, and probably
pafs off unchanged by the excretions, fo
Vol. IV. E e they
426 PRACTICE
they can do little in changing the ftate of
the fluids.
MDCCCVIIL
The great debility which conftantly at-
tends fcurvy, has naturally led phyficians
to employ tonic and ftrengthening medi-
cines, particularly the Peruvian bark; but
the efficacy of it feems to me very doubt-
ful. It is furprifing how foon the ufe of
a vegetable diet reftores the ftrength of
fcorbutic perfons; which feems to (how
that the preceding debility had depended
upon the ftate of the fluids; and confe-
quently, till the found ftate of thefe can be
reftored, no tonic remedy can have much
effetfi: but as the Peruvian bark has little
power in changing the ftate of the fluids,
fo it can have little effe<ft in fcurvy.
MDCCCIXo
OF P H Y S I C. 427
mdcccix:
I fhall conclude my obfervations upon
the medicines employed in fcurvy, with
remarking, that the ufe of mercury is al-
ways manifeftly hurtful.
MDCCCX.
After having obferved that both the pre
vention and cure of this difeafe are now
very well known, it may feem unneceflary
to enter into much difcuflion concerning
its proximate caufe: but as i'uch difcuffions
can hardly be avoided, and as falfe opi-
nions may in fome meafure corrupt the
pradlice, I fliall venture to fugged here
what appears to me mod probable upon
the fubjeft.
Ee2 MDCCCXL
4*8 PRACTICE
MDCCCXI.
Notwithstanding what has been afferted
by forne eminent perfons, I truft to the
concurring teftimony of the raoft part of
the authors upon the fubjeft, that in fcur-
vy the fluids fuflfer a confiderable change.
From thefe authors we learn, that in the
blood drawn from the veins of perfons la-
bouring under the fcurvy, the craflamen-
tum is different both in colour and con-
fidence from what it is in healthy per-
fons; and that at the fame time the ferum
is commonly changed both in colour and
tafte. The excretions alfo, in fcorbutic
perfons, (how a change in the ftate of the
fluids. The breath is fetid ; the urine i$
always high-coloured, and more acrid tha.n
ufual ; and if that acrid exfudatio.n from
the feet, which Dr Hulme takes notice of,
happens efpecially in fcorbutic perfons, it
will be a remarkable proof to the fame
purpoff.
O F P H Y S I C. 429
purpofe. But however this may be, there
is evidence enough that in icurvy the na*
tural ftate of the fluids is confiderabi^
changed. Further, 1 apprehend it may be
confidently prefumed from this, that the
difeafe is brought on by a particular nou*
riflimenc introduced into the body, and is
as certainly cured by the taking in of a
different diet. In the latter cafe, the diet
\ifed has no other evident operation, thaii
that of giving a particular ftate and con*
dition to the fluids.
MDCCCXII.
Prefuming, therefore, that the difeafe
depends upon a particular condition of the
fluids of the body, the next fubje<5t of in-
quiry is, What that condition may be?
With this view, I muft obferve, that the
animal ceconomy has a Angular power of
changing acefcent aliments, in fuch a
E e 3 man-
43Q PRACTICE
manner, as to render them much more dif-
pofed to putrefaction ; and although in a
living ftate, they hardly ever proceed to an
actually putrid ftate ; yet in man, whofe
aliment is of a mixed kind, it is pretty cer-
tain, that if he were to live entirely upon
animal food, without a frequent fupply of
vegetable aliment, his fluids would ad-
vance further towards putrefaction than
is confident with health. This advance
towards putrefaction feems to confift in the
produ&ion and evolution of a faline mat-
ter which did not appear in the vegetable
aliment, and could not be produced or e-
volved in it, but by carrying on its fer-
mentation to a putrefactive ftate. That
this faline ftate is conftantly in fome mea-
fure produced and evolved by the animal
procefs, appears from this, that certain ex-
cretions of faline matter are conftantly
made from the human body, and are there-
fore prefumed necefTary to its heafth.
From
OF PHYSIC. 431
From all this, it may be readily under-
ilood, how the continual ufe of animal
food, efpecially when already in a putre-
scent Hate, without a mixture of vegetable,
may have the effect of carrying the animal
procefs too far, and particularly of produ-
cing and evolving a larger proportion of
faline matter. That fuch a preternatural
quantity of faline matter does exift in the
blood of fcorbutic perfons, appears from
the ftate of the fluids above-mentioned. It
will be a confirmation of all this to ob-
ferve, that every interruption of perfora-
tion, that is, the retention of faline mat-
ter, contributes to the production of fcur-
vy ; and this interruption is efpecially ow-
ing to the application of cold, or to what-
ever elfe weakens the force of the circula-
tion, fuch as the negled or want of exer-
cife, fatigue, and defpondency of the mind.
It deferves indeed to be remarked here,
that one of the lirft effects of the fcurvy
E e 4 once
4j2 PRACTICE
once induced, is very foon to occafion a
great debility of the fyftem, which occa-
fions of courfe a more rapid progrefs of the
difeafe. How the ftate of the fluids may
induce fuch a debility is not well under-
ftood ; but that it does depend upon fuch
a ftate of the fluids, is rendered fufficient-
ly prefumable from what has been faid a-
bove with regard to both the caufes and
the cure of fcurvy.
MDCCCX1II.
It is pofiible that this debility may have
a great fhare in producing feveral of the
phenomena of fcurvy; but a preternatu-
rally faline, and confequently diffolved,
ftate of the blood, will account for them
with more probability; and I do not think.
ic neceflary to perfons who are at all accu-
ftomed to reaibn upon the animal (Econo-
my, to explain this matter more fully. I
have
OF PHYSIC. 433
have only to add, that if my opinion in fup-
pofing the proximate caufe of fcurvy to be
a preternaturally ialine ftate of the blood
be at all founded, it will be fufficiently ob-
i vious, that the throwing into the body a-
long with the aliment an unufual quanti-
ty of fait, may have a great (hare in pro-
ducing the difeafe. Even fuppofing fuch
fait to fuffer no change in the animal bo-
dy, the effect of it may be confiderable ;
and this will be rendered ftill more pro-
bable, if it may be prefumed, that all neu-
tral falts, confiding of a fixed alkali, are
changed in the animal body into an am-
moniacal fait; which 1 apprehend to be
that efpecially prevailing in fcurvy. If I be
at all right in concluding, that meats,
from being faked, contribute to the pro-
duction of fcurvy, it will readily appear,
how dangerous it may be to admit the
conclufion from another theory, that they
are perfe&ly innocent.
MDCCCXIV.
434
PRACTICE
MDCCCXIV
Having thus endeavoured to explain
what relates to the cure of fcurvy in gene-
ral, I judge it proper to leave to other au-
thors, what relates to the management of
thofe fymptoms which require a particu-
lar treatment.
CHAP.
A
OF PHYSIC. 435
CHAP. IV.
Of JAUNDICE.
MDCCCXV.
I Have here palled over feveral of the
titles in my nofology, becaufe they are
difeafes not of this Ifland. In thefe, there-
fore, 1 have no experience ; and without:
that, the compiling from other writers is
always extremely fallacious. For thefe rea-
fons I omit them j and mall now only of-
fer fome remarks upon the fubjeft of jaun-
3 dice.
I!
436
PR ACTIGE
dice, the laft in order that I can poflibly
introduce in my courfe of Lectures.
MDCCCXVI.
The jaundice confifts in a yellow colour
of the fkin over the whole body, and par-
ticularly of the adnata of the eyes. This
yellow colour may occur from different
caufes : but in thejaundicej hereafter to
be more exadlly chara&erifed, I judge it
to depend upon a quantity of bile prefent
in the mafs of blood ; and which, thrown
out upon the furface, gives its own proper
colour to the fkin and eyes.
MDCCCXVII.
That the difeafe depends upon this, we
know particularly and certainly from the
caufes by which it is produced. In order
to explain thefe, I mull obferve> that bile
3 does
O F P H Y S I C. 437
does not exifl; in its proper form in the
mafs of blood, and cannot appear in this
form till it has patted the fecretory organ
of the liver. The bile therefore cannot
appear in the mafs of blood, or upon the
furface of the body, that is, produce jaun-
dice from any interruption of its fecre-
tion ; and accprdingly, |f jaundice does
appear, it muft be in confequence of the
bile, after it had been fecerned, being a-
gain taken into the blood- veflejs.
This may happen in two ways ; either
by an interruption of its excretion, that is,
of its pafTage into the duodenum, which
by accumulating it in the biliary veffels,
may give occafion to its palling again into
the blood- veffels ; or it may pafs into
thefe, by its being abforbed from the ali-
mentary canal when it happens to be ac-
cumulated there in an unufual quantity.
How far the latter caufe can take place,
or \n what circumftances it does occur,
I
438 PRACTICE
I cannot clearly afcertain, and I apprehend
that jaundice is feldom produced in that
manner.
MDCCCXVIIL
The former caufe of flopped excretion
may be underftood more clearly ; and we
have very certain proof of its being the
ordinary, and indeed almoft the univerfal,
caufe of this difeafe. Upon this fubjed it
will be obvious, that the interrupted ex-
cretion of the bile muft depend upon an
obftrudion of the duElas communis chcle-
dochus ; the mod common caufe of which
is a biliary concretion formed in the gall-
bladder, and from thence fallen down into
the dudus communis, it being at the fame
time of fuch a fize as not to pafs readily
through that dud: into the duodenum.
This dud: may likewife be obftruded by a
fpafmodk conftridion affeding it: and
} fuch
OF PHYSIC. 439
fuch fpafm may happen, either in the duel
itfelf, which we fuppofe to be contraclile ;
or in the duodenum prefling the fides of
the duel clofe together ; or, laftly, the
duel may be obftrucled by a tumour com-
pelling it, and that arifing either in the
coats of the duel itfelf, or in any of the
neighbouring parts that are, or may come
to be, contiguous to it,
MDCCCXIX.
When fuch obflruclion happens, the fe-
creted bile mufl be accumulated in the bi-
liary duels; and from thence it may either
be abforbed and carried by the lymphatics
into the blood-vefTels, or it may regurgi-
tate in the duels themfelves, and pafs from
them direclly into the afcending cava. In
either ways, it comes to be diffufed in the
mafs of blood; and from thence may pafs
by every exhalant vefTel, and pivaduce the
difeafe in queftion.
MDCCCXX. *
44Q PRACTICE
MDCCCXX.
I have thus fhortly explained the ordi-
nary produ&ion of jaundice ; but it muft
be obferved further, that it is at all times
accompanied with certain other fymptoms,
fuch as a whitenefs of the faces alvinczy
which we readily account for from the ab-
fence of bile in the inteftines ; and general-
ly, alfo, with a certain confidence of the fae-
ces, the caufe of which is not fo eafy to ex-
plain. The difeafe is always accompanied
alfo with urine of 3. yellow colour, or at
leaft with urine that tinges a linen cloth
with a yellow colour. Thefe are conftant-
ly attending fymptoms ; and though not
always, yet there is commonly, a pain
felt in the epigaftrium, correfponding,
as we fuppofe, to the feat of the ductus
communis. This pain is often accom-
panied with vomiting ; and even when
the pain is not confiderable, a vomiting
fome^
Of PHYSIC. 44!
fometimes occurs. In iome cafes, when
the pain is confiderable, the pulfe becomes
frequent, full, and hard, and forne other
fymptoms of pyrexia appear.
MDCCCXXt.
When the jaundice is occafioned by tu-
mours of the neighbouring parts compref-
fing the biliary dud, I believe the difeafe
can very feldom be cured. That fuch is
the caufe of jaundice, may with fome pro-
bability be fuppofed, when it has come on
in confequence of other difeafes which had
fubfifted long beforehand more efpecially
fuch as had been attended with fymptoms
of obftructed vifcera. Even when the jaun-
dice has fubfifted long without any inter-
miffion, and without any pain in the epi-
gaftrium, an external compreffion is to be
fufpe&ed.
Vol. IV. rf MDCCCXXIT,
442 PRACTICE
MDCCCXXII.
In fuch circumftances, I confider the
difeafe as incurable ; and it is almoft only
when the difeafe is occafioned by biliary
concretions obftrudting the biliary du£t,
that we may commonly expe<5t relief, and
that our art may contribute to the obtain-
ing it. Such cafes may be generally known,
by the difeafe frequently difappearing and
returning again ; by our finding, after the
former accident, biliary concretions a-
mongft the faeces ; and by the difeafe be-
ing frequently accompanied with pain of
the epigaftrium, and with vomitings ari-
ling from fuch pain.
MDCCCXXIII.
In thefe cafes, we know of no certain
and immediate means of expediting the
paffage of the biliary concretions. This
is
O F PHYSIC. 443
is generally a work of time, depending
upon the gradual dilatation of the biliary
duct ; and it is iurpriling to obferve,
from the fize of the ftones which feme-
times pafs through, what dilatation the
duct will admit of. It proceeds, however,
fafter or flower upon different occafions ;
and therefore the jaundice, after a various
duration, often ceafes fnddenly and fpon-
taneoufly. It is this which has given rife
to the belief, that the jaundice has been
cured by fuch a number and fuch a variety
of different remedies. Many vof thefe,
however, are perfectly inert, and many
others of them fuch as cannot be fuppofed
to have any effect in expediting the paf-
fage of a biliary concretion. I fhall here,
therefore, take no notice of the numerous
remedies of jaundice mentioned by the
writers on the Materia Medica, or even of*
thofe to be found in practical authors ;
but fhall confine myfelf to the mention of
F f 2 thofe
444 PRACTICE
thofe that may with probability be fuppo-
fed to favour the paflage of the concretion,
or remove the obftacles to it which may
occur.
MDCCCXXIV.
In the treatment of this difeafe, it is,
in the firft place, to be attended to, that
as the diftention of the biliary dudt, by a
hard mafs that does not eafily pafs through
it, may excite inflammation there ; fo, in
perfons of tolerable vigour, blood-letting
may be an ufeful precaution ; and when
much pain, together with any degree of
pyrexia, occurs, it becomes an abfolutely
neceffary remedy. In fome inftances of
jaundice accompanied with thefe fymp-
toms, I have found the blood drawn co-
vered with an inflammatory cruft as thick
as in cafes of pneumonia.
i MDCCCXXV.
O F P H Y S I C. 445
MDCCCXXV.
There is no means of pufhing forward
a biliary concretion that is more probable
than the aiflion of vomiting ; which, by
comprefling the whole abdominal vifcera,
and particularly the full and diftended
gall-bladder and biliary vefTels, may con-
tribute, fometimes gently enough, to the
dilatation of the biliary ducfl. Accordingly
vomiting has often been found ufeful for
this purpofe : but at the fame time it is
poflible, that the force exerted in the adt of
vomiting may be too violent, and there-
fore gentle vomits ought only to be em-
ployed. And either when, by the long
continuance of the jaundice, it may be fu-
fpecled that the fize of the concretion then
parting is large ; or more efpecially when
pain attending the difeafe gives apprehen-
sion of inflammation, it may be prudent
to avoid vomiting altogether.
Ff 3 MDCCCXXVI.
446
PRACTICE
MDCCCXXVI.
It has been ufual in the jaundice to em-
ploy purgatives ; and it is poffible that the
action of the inteflines may excite the ac-
tion of the biliary duels, and thus favour
the expulfion of the biliary concretion :
but this, 1 think, cannot be of much effect;
and the attempting it by the frequent ufe
of purgatives, may otherwife hurt the pa-
tient. For this reafon I apprehend, that
purgatives can, never be proper, excepting
when there is a flow and bound belly.
MDCCCXXVII.
As the relaxation of the fkin contri-
butes to relax the whole fyftem, and parti-
cularly to relieve the conftriclion of fubja-
cent parts ; fo, when the jaundice is at-
tended with pain, fomentations of the epU
raftrium may be of fervice.
MPCCCXXVI1L
OF PHYSIC. 447
MDCCCXXVIH.
As the folida of the living body are very
flexible and yielding; fo it is probable,
that biliary concretions would in many ca-
fes find the biliary duel readily admit of
fuch dilatation as to render their paflage
through it eafy, were it not that the diften-
tion occafions a preternatural fpafmodic
contraction of the parts below. Upon this
account, opium is often of great benefit in
jaundice; and the benefit refulting from
its ufe, proves fufficiently the truth of the
theory upon which the ufing of it has
been founded,
MDCCCXX1X.
It were much to be wifhed, that a fol-
vent of biliary concretions, which might
be applied to them in the gall-bladder or
biliary duels, was difcovered : but none
F f 4 fuch,
448
PRACTICE
fuch, f j far as I know, has yet been found;
and the employment of foap in this dif-
eafe, I confider as a frivolous attempt. Dr
White of York has found a folvent of bi-
liary concretions when thefe are out of the
body ; but there is not the leaft probabi-
lity that it could reach them while lodged
within.
INDEX
INDEX
To the FOUR VOLUMES.
N. B. The Cyphers refer to the number of the Paragraphs .
jfVBSCESS, s5o
Abscesses and ulcers, the caufes of their dif-
ferent dates, 254
Acids employed in fever, 134
refrigerant in fever, 134
Action of the heart and arteries, how increafed
for preventing the recurrence of the paroxyfms
of intermitting fever, 230
Adynamic, 1171
Amenorrhoei, 995
from retention, 996
when occurring, 998
fymptoms of, 999
Ame-
45°
N D
Amenorrhoea, from retention, caufes of, iooo — 2
cure of, 1002 — 6
from fuppreflion, 996
when occurring, 1008
fymptoms of, 10 10
caufes of, 1008 — 9
cure of,
1011 — 12
1598
j 668
i663
1668—73
1674—96
Amentia,
Anasarca,
the character of,
phenomena of,
cure of,
diftinguifhed from Leucophlegmatia, 1669
St Anthony's Fire. See Erythema,
Antimonial emetics, employed in fevers, 181
their different kinds, 181
the adminiftration of
them in fevers, 1 83 — 1 86
Antiphlogistic Regimen, 129
how conducted, 130
when employed in in-
termittent fever, 234
Antispasmodics, employed in fevers, 152 — 187
Aphtha, 733
Apoplexy, 1094
diftinguifhed from palfy, 1094
diftinguifhed from fyncope, 1094
Apo»
I N D B X. 45 x
Apopi fxy, predxfponent caufcs of, I095
exciting caufcs of, 1098 — 11 15 — 16
proximate caufe of, 1 ico — 21
serosa, proximate caufe of, 1 1 14
prognoftic, 11 22 — 23
frequentjy ending in hemi-
plegia, 1 122
prevention of, 1 124
whether fanguine or ferous, ftimu-
lants hurtful in it, 1136 — 37
from powers that deftroy the mobi-
lity of the nervous power, 1 13S
cure of, 1 13 1 — 39
Apyrexia, 24
Ascites, 1709
character of, J709
its various feat, 1 7 1 o — 1 1
the phenomena of, 17 12 — 13
its particular feat difficultly afcer-
tained, 17 14
the cure of, 1 71 5 — iy
Asthma, 1373
phenomena of, x375
exciting caufes of, 1 381
proximate caufe of, l3%4
diftinguifhed from other kinds of
dyfpnoea, 138 c
Asthma,
452 INDEX.
AsTiJMA,fometimesoccafionsphthifispulmonalis, 1386
frequently ends in hydrothorax, 1386
feldom entirely cured, 1387
Astringents employed in intermittent fevers, 231
joined with aromatics, employed in
intermittent fevers, 231
joined with bitters, employed in in-
i
termixtent fevers,
231
Atrabilis,
1029
Atrophia ab alvi fluxu,
1607
debilium,
1606
inanitorum,
1607
infantilis,
1605
Ja&antium,
1605
lateralis,
r6o6 — 1 c
•4 leucorrhcea,
1607
nervofa,
1606
nutricum,
1607
3 ptyalifma,
1607
rachitica,
1605
fenilis,
1606 — ( I
Aura Epileptica,
1306
B.
Bitters employed in intermittent fevers, 231
joined with aftringents, employed in
intermittents, 231
Eli-
[
INDEX. 453
Blistfrinc, its effects, 189— T97
its mode of operation in the cure
of fevers, 190 — 194
when to be employed in fevers, 195
where to be applied in fevers, 196
Bi.ood-letting, the employment of it in
fevers, 138 — 143
the circumftances directing its ufe
in fevers, 142
the adminiftration of it in fevers, 143
when employed in intermittent
fevers, 234
C.
Cachexies, character of the clafs, 1599
Cachexy, the term, how applied by authors, 1600
Calculus renalis, 429
Calx nitrata antimonii, its ufe in fe-
vert,
183—185
Canine madness,
1525
the cure of,
J525— '5*7
Cardialgia,
1427
Carditis,
383
of the chronic kind
383
Carus,
1094
Cataphora,
1094
Catarrh,
1046
Ca.
454 INDEX.
Catarrh, predifpofition to, I04 •,
fymptoms of, 1048
remote caufes of, 1047
proximate caufe of, 1057
cure of, 1065
produces phthifis, 10S3
pafles into pneumonia, 1054
produces a peripneumonia notha, 1056
contagious, 1062
Catarrhus suffocativus, 376
Chancre, method of treating, 1781
Chicken-pox, 631
how diftinguifhed from fmall-pox, 632
Chincough, 1402
contagious, 1402
frequently accompanied with fever, 14 10
phenomena,
1404
prognoftic in,
i4'3
cure of,
1 4 14
Chlorosis,
998
Cholera,
*453
fymptoms of,
*453— 56
remote caufes of,
1 45 8 — 60
proximate caufes of,
M54
cure of,
1462 — 64
Chorea,
1347
phenomena.
1347—53
Cho-
INDEX. 4SS
Chorea, cure of, 1354
Chronic weaknefs, 1191
Coeliaca, 1493
Cold, its operations, 88
abfolute, 88
relative, 89
its general effects on the human body, 90— 9 1
its morbid effects, 92
moderates the violence of reaction in fever, 133
its tonic power, how to be employed in
fevers, 205
Cold drink, an ufeful tonic in fevers, 206
the limitation of its ufe in fevers, 207
air applied in fevers, 208
water applied to the furface of the body in
fevers, 205—209
Colic, 1435
fymptoms of, 1435 — 38
proximate of, 1439
cure of, 1 44 1
Devonfhire. See Colic of Poitou.
of Poitou, 1 4 5 1
cure of, 1452
Coma, 1094
Comata, 1093
Contagions, 78
their fuppofed variety, 79
Con-
45<5 I N D E X
Convulsions, 1253
Corpulency, 1621
Cynanche, Jao
MALIGNA, 3U
PAROTIDES, 33*
PHARYNGEA, 331
TONSILLARIS, 301
TRACHEALIS, 318
as affecting infants, 322 — 329
the cure of it, 330
Cystitis, 431
D.
Da?s, critical, in fevers, 107 — 124
non- critical, 113
Death, the caufes of, in general, 100
the direct caufes of, 100
the indirect caufes of, 10b
the caufes of in fever, 101
Debility in feverj, the fymptoms of, 104
how obviated, 202
Delirium in general, explained, JS29 — 5°
in fever, of two kinds, 45
or insanity without fever, 1550 — 57
Diabetes, 1504
iymptoras of, 1504 — 9
Dm-
i n
45?
1510 — 12
1513
"57
Diabetes, remote caufes of,
proximate caufe ©f<
cure of,
Dimta Aquea,
Diarrhoea, 1465
diftinguifhed from dyfentery, 1466
diltinguiftied from cholera, J 4^7
proximate caufe ofj 1468
remote caufes of, 14 71 — 93
cure of, 1494—1503
biliosa, 1480
COLLIQUATIVE, IjOl
MUCOSA, I488
Diathesis phlogistica, 62 — 247
how removed, 266
Diluents, their ufe in fevers, * 154 — 158
DiSEASES,thediftinguifhingofthem, how attained, 2
the prevention of them, on what founded, 3
the cure of them, on what founded,
Dropsies,
in general, the caufe of them,
of the breaft. See Hydrothorax*
of the lower belly. See Afcitcs*
Dysentery,
contagious,
remote caufes of,
proximate caufe of,
Vol. IV, Gg
4
1645
1646
1067
107$
1072
f377
Dt-
4S8 INDEX.
Dysentery, cure of, 108$
tife of mild cathartics to be fre-
quently repeated in it, 1080
rhubarb improper in it, io8d
Dysenteria alba, 1070
Dysmenorrhea, 1014
Dyspepsia, 1190
remote caufes of, 11 98
proximate caufe of, 1 193
cure of, 1 20 1
flatulence in it, cure of, 1221
heart-burn in it, cure of, 1221
pains of ftomach in it, cure of, 1221
vomiting in it, cure of, 1221
Dyspnoea, 1365
Effluvia, human, 8$
from marfhes, 85
Emaciations, 1600
caufes of, 1602 — 18
cure of, \6 1 9
Emansio mensium, 998
Emetics, fuited to the cure of fevers, 174
their effecls, 1 76 — 1 80
a mean of removing fpafm, 170
the adminiftration of in fevers, 1 75
Eme«
INDEX. 4S9
Emetics, their ufe in intermittent
fevers,
230-
-233
Emprosthotonos,
1267
Enteritis,
404
phlegmonic or crythematie,
404
caufes of,
407
cure of,
409
Epilepsy,
1282
phenomena of,
1283
proximate caufes of,
1284
remote caufes of,
1285
predifponent caufes of,
1310
fympathic,
1316
cure of,
1317
idiopathic,
1316
cure of,
1319
Epistaxis,
806
the caufes of it,
808
the various circumftances of,
807.
—818
the management and cure of,
819
—829
Erysipelas,
274
of the face,
708
fymptoms of,
705.
—708
prognofis of,
706
proximate caufe of,
697
cure of,
708
—711
phlegmonodes in different
parts of
the body,
712
Cgi
F.RY-
40*0
INDEX.
Ery§ipelas, attending putrid fever,
Erythema,
Exanthemata,
Exercise, ufcful in intermittent fevers,
713
274
231
Fainting. Sec Syncope. 1171
Fatuity, 1529
Fear, a remote caufe of fever, 97
Fever, 8
ftri&ly fo called, the character of, 8 — 3 2
phenomena of, 8
remote caufes of, are of a fedative na-
ture, 36
proximate caufe of, 33
atony of the extreme vefTels, a princi-
pal circumfbnce in the proximate caufe
of it, 43—44
fpafm, a principal part in the proximate
caufe of it, 40
general doftrine of, ^
the caufes of death in it, i0I
the prognofis of, 9^
indications of cure in, 126
differences of, 53
Fever,
I N D e :
Fever, continent,
continued,
inflammatory,
miliary. See Miliary Fever.
nervous,
bilious,
fear let. See Scarlet Fever*
putrid,
named fynocha,
fynochus,
typhus,
hc&c,
461
28
67
67
7*
72
<*7
69
67
74
intermittent, the paroxyfms of, defcribed, 10
the cold ftage of, 1 1
the hot ftage of, 1 1
the fwcating ftage of, 1 1
of a tertian period, 25
of a quartan period, 2C
of a quotidian period, 25
caufed by marfh effluvia, 84
bile not the caufe of it, 5 1
cure of, 228
its paroxyfms, how prevent-
ed, 229
attended with phlogiftic di-
athefis, 274
G g 3 Fe-
462
I N D
Fever, intermittent, attended with congeftion in
the abdominal vifcera, 234
remittent, 26
Fluxes, without fever. See Profluvia.
Fluor albus. See Leucorrhoea.
Fomentation of the lower extremities, its ufe
in fevers, 199
Fo m 1 t E s of contagion, 8 2
Functions intellectual, diforders of, 1528 — 29
G.
Gangrene of inflamed parts, the caufe of,
255—256
marks of the tendency to,
257
marks of its having come on,
257
Gastritis*
384
phlegmonic or crythematic,
38*
phlegmonic, the feat of,
385
the fymptoms of,
336
the caufes of,
387
the cure of,
393—392
erythematic, how difcovered,
400
the feat of,
38s
the cure of,
401
Gastrodynia,
1427
Gleet,
1769
Gonorrhoea,
i76r
phenomena of,
1767—69
Go-
INDEX. 4*3
Gonorrhoea, cure of, 1770 — 78
Gout, the character of, 492
a hereditary difeafe, 500
diftinguifhed from rheumatifm, 526
predifponcnt caufes of, 493 — 500
oceafional caufcs of, 502 — 505
proximate caufe of, 527 — 533
not a morbific matter, 529
Regular, defcribed, 506 — 518
pathology of, 533
cure of, 537—573
no effectual or fafe remedy yet
found for the cure of it, 539
medicines employed for it, 556
whether it can be radically cured, 540
treatment in the intervals of pa-
roxyfms, 542
treatment in the time of pa-
roxyfms, 560
regimen during the paroxyfms, 561
external applications, how far
fafe, 568 — 569
blood-letting in the intervals of
paroxyfms, 553
■ in the time of pa-
roxyfms, $ 63
coftivenefs hurtful, 559
G g 4 Gout9
464 I N
Regular, laxatives to be cmpl<
ayed,
559
effects of alkalines,
5S«
effe&s of Portland j
iowdei
■ 557
Irregular,
518
Atonic,
574-579
pathology of,
534
cure of,
580—582
Ret roce dent,
522
pathology of,
535
cure of,
580—582
Mi/placed,
523
pathology of,
53°*
cure of,
583-5*4
Tranjlated, two particuiai
p cafes
of, 525
H.
H^MATEMESIS, IOI7
arterial and venous, 1027
from obftructed menftruation, 1029
from fuppreflion of the hemor-
rhoidal flux, 1025
from compreffion of the vafa
brevia, by the fpleen, 2027
from obftru&ion of the liver, 1028
HEMATURIA, IO33
idiopathic, improbable, 1033 — 34
I N D E X. 4*3
Hematuria, calculofa, 1037
cure ot 1038
vioUnta, 1039
from fuppreflion of accuflomcd
difcharges, 104 1
putrida, 1043
fpuria et lateritia, 1044
Hemiplegia, 1 140
caufes of, 1 141
frequently occafioned by apo-
plexy, 114*
frequently alternates with apo-
plexy, 1 144
cure of, 1 152
ftimulants, of ambiguous ufe in, 1 160
ftimulants, external in 1 161
HEMOPTYSIS,
the fymptoms of, 838 — 840
the caufes of, 760 — 63 — 830 — 836
how diftinguifhed from other fpit-
tings of blood,
841—45
cure of,
846—51
Hjemorrhagia uteri,
966
Hemorrhagy,
active or paflive,
73*
character of,
736
arterial,
741
Hem or-
A66 INDEX.
Hemorrhagy, venous, 768
the caufes of the different fpe-
cies appearing at different pe-
riods of life, 750 — 773
the general phenomena of, 738 — 743
the remote caufes of, 774
cure of, 776
whether to be attempted
by art, 776—81
prevention of the firft attacks, or
of the recurrence of, 782 — 789
treatment of when prefent, 789 — 805
fymptomatic, 1015
HiEMORRHOIDES VESICA, IO42
HJEMORRHOIS,
external and internal, 925
phenomena of, 925 — 93 1
nature of the tumours, 932
caufes of, 933 — 943
acquire a connection with the
fyftem, 943—944
particularly with the ftomach, 946
cure of, 947 — 96$
Hepatirrhoea, 1481
Hepatitis, 41*
acute and chronic, 4 1 2
Hepa-
I N D E 4^7
Hepatitis, acute, the fymptoms of, 413 — 415
combined with pneumonic
inflammation, 416
remote caufes of it, 416
feat of, 418
various exit of pus produced
in, 421
cure of, 422
chronic, the feat of, 418
how discovered, 423
Hooping-cough. See Ckincough. 1402
Horror, impreflion of, employed in intermittent
fevers, 231
Human effluvia, the caufe of fever, Si
body, its temperature, 88
body has a power of generating heat, 88
Hydrophobia, 1525
Hydrothorax, 1697
where feated, 1698
fymptoms of, 1701 — 03
often combined with univerfal
dropfy, 1 704
proximate caufe of, 1706
cure of, 1707—08
paracentefis in it, when pro-
per, 1708
Hypercatharsis, I477
Hypo-
468 INDEX.
Hypochondriasis, 1222
phenomena of, 1222
diftinguifhed from dyfpepfia, 1226
proximate caufe of, 1230
cure of, 1232
treatment of the mind in, 1 244
Hysteria, 15 14
fy mptoms of, 1 5 1 5 — \6
paroxyfm or fit defcribed,
1515— 16
rarely appears in males,
1517
how diftinguifhed from
hypo-
chondriafis,
1518— 19
proximate caufe of,
1522
analogy between and epilepfy,
*523
cure of,
1524
libidino/a3
"5*7
Hysteric difeafe. See Hyfteria,
I.
James's powder, its ufe in fever,
183
Jaundice,
1815 — 16
caufes of,
1816—21
cure of,
1823—29
Icterus. See Jaundice.
Iliac pafiion. Sec Ileus.
Ileus,
INDEX. 469
Ileus,
1437
Impetigines,
1737
character of the order,
1737
Indigestion.
See Dyfpepfia.
Inflammation, the phenomena of,
23;
internal, the marks of,
236
the ftate of the blood in,
237
the proximate caufe of,
239
not depending upon a
lentoi
of the blood,
241
fpafm the proximate
caufe
of,
243.
-248
terminated by refolution,
249
by fuppuratior
'*
250
by gangrene,
25*
by fcirrhus,
258
by effufion,
259
by blifters,
260
by exfudation,
261
the remote caufes of,
262
the cure of in general,
264
by refolution,
264
when tending
to
fuppuration,
268
-70
when tending
to
gangrene,
271
In-
470 I N D E X
Inflammation, its general divifions, 273
more ftridtly cutaneous, 274
of the bladder4. See Cyfiitis*
of the brain. See Phrenitis.
of the heart. See Carditis.
of the interlines. See Enteritis.
of the kidneys. See Nephritis.
of the liver. See Hepatitis.
of the lungs. See Pneumonia.
of the pericardium. See Pericarditis.
of the peritonaeum. See Peritonitis.
of the fpleen. See Splenitis.
of the ftomach. See Gajlritis*
of the uterus, 431
Insanity, 1535
caufesof, 1550 — 57
of different fpecies, 1557
partial and general, difference of, 1575
Intemperance in drinking, a remote caufe
of fever, 97
Intermission of fever, 24
Interval of fever, 24
Intumescenti^, 1620
character of the order, 1629
K.
King's Evil. See Scrophula.
1 Uuofl-
INDEX, 471
Leucophlegmatia, 1669
Leucorrhoea, 985
character of, 986
appearance of the matter difchar-
ged in, 987— 992
the caufes of, 988
the effects of, 990
the cure of, 993
Lethargus, 1094
LlENTERY, I469
Looseness. See Diarrh&a.
Madness. See Mania*
canine. See Canine*
Mania, 1558
the fymptoms of, 15^8
the remote caufes of, 1 559 — 61
the treatment of, 1562 — 74
occurring in fanguine temperaments, 1576
in fanguine temperaments, cure of, 1577
Marcores, 1600
Marsh effluvia, a caufe of fever, 84
Measles, 633
the fymptoms of, 637 — 642
the nature of, 644
the cure of, 64$— 650
of a putrid kind, 643
Me-
47* INDEX.
Medicine, the inftitutions of, 4
Mel^na, 1017
Melancholia, 1575
how diftinguifhed from hypo-
chondriafis
1587—88
the character of,
1582—89
the proximate caufe of,
1590
the treatment of,
1592—97
Melancholic temperament,
1230
Melancholy. Sec Melancholia,
Menorrhagia, •
966
aclive or paflive,
»66
when a difeafe,
968-75
effects of,
0
972
proximate caufe of,
977
remote caufes of>
978
cure of,
980
Menses, immoderate flow of them.
See
Menorrhagia*
Metallic Tonics, employed in
intermittent
fevers,
231
salts, refrigerant,
13d
Meteorismus,
I633
Miasmata,
7*
Miliary Fever,
the general hiftory of, 714 — 71$
of two kinds, red and white, 7 1 6
1 Mi*
I N D E 473
MiliAry fever, white) the fymptoms of, 717 — 71^
the cure of, 720
Morbus coeliacus, 1493
muc03us, io7o
NIGER, IO29
Nephritis, ■ 426
the fymptoms of, 426
the remote caufes of, 427
the cure of, 430
Nervous Diseases. See Neurcfes.
Neuroses, 1090
Neutral Salts, diaphoretic in fevers, 159 — 161
refrigerant in fevers, 13 e
Nosology, Methodical, 2
O.
Obesity, when a difeafe, 1621
Oneirodynia, 1598
Ophthalmia, 278
membranarum, 278
its different degrees, 279 — 280
its remote caufes, 280
the cure of, 288 — 290
tarfi, 278
the cure of, 288 — 290
Opiates, employed in the hot flage of inter-
mittent fevers, 233
in the interval of intermittent fevers, 231
Opisthotonos. See Tetanus.
Vol. IV Hh Pat
474 INDEX.
P.
Palpitation of the heart,
1355
the phenomena of!,
1355
the caufes of,
*356
the cure of,
1363
Palsy,
1 140
diftinguifhed from apoplexy,
1094
caufes of,
1 141
Paracentesis inafcites, when to be attempted, 1717
in hydrothorax, when proper, 1708
Paraphrenitis, 343
Paroxysm of intermittent fevers, the recur-
rence, how to be prevented, 229
Pemphigus, 732
Pericarditis, 383
Peripneumonia notha, 376
fymptoms of, 379
pathology of, 380
the cure of, 381—382
fome of the fymptoms explained, 350
Peripneumony, 342
Peritonitis, 384
Peruvian bark, not a fpeciiic, 213
its tonic power, 214
when proper in fever, 2 1 5
how mod effectually employed, 216
Peru-
INDEX. 47fj
Peruvian bark, the adminiftration of,in inter-
mittent fevers, 232
the tonic chiefly employed in inter-
mittcnt fevers,
232
Petechia,
734
Phlegmasia,
235
Phlegmon,
274
Phrenitis,
291
the character of,
293
the remote caufes of,
294
the cure of, 295-
-299
Phrensy. See Phrenitis.
Physic, the practice of, how taught,
1
the theory of, how to be employed,
4
Physconia,
1718
Phthisis pulmonalis, the general character of, 853
always with an ulceration of the lungs, 85 -
the pus coughed up, how diflinguifh-
ed from mucus,
856
accompanied with hectic fever,
857
the various caufes of it,
863
from hxmoptyfis,
864— 86^
from pneumonia,
866—869
from catarrh,
870-873
from afthma,
875
from tubercles,
876—882
Hh2
Phthi-
A16 INDEX,
Phthisi9 pulmonalij, from calcareous mat-
ter in the lungs, 884
if contagious, 886
from tubercles, fymptoms of, 889
its different duration, 896
the prognofis in, 897
the cure of, 899 — 924
the treatment of when arifing from tu-
bercles,
906 — 921
the palliation of fymptoms,
922 — 924
Plague,
the general character of,
66s
phenomena of,
66s
principal fymptoms of,
667
proximate caufe of,
668
prevention of,
670 — 685
^ure of,
686— 69s
Pleurisy,
34i
Pleu ro^thotonos. Set Tetanus.
Pneumonia, or pneumonic inflammation, 334
general fymptoms of,
335—339
feat of,
340—344
prognofis of,
352—360
cure of,
361
the management of blood
-letting in
the cure of,
362—367
the ufe of purgatives in,
370
2
Pneu-
N D
477
Pneumonia, the ufe of emetics in, 371
the ufc of bliflers in, 372
the means of promoting expectora-
tion in, 373
the ufe of f wearing in, 374
the ufe of opiates in, 375
Polysarcia, when a difeafe, 1621
cure of, 1623 — 25
Profluvia, 1045
character of the clafs, 1045
Pulse, the (late of the, during the paroxyfm of
an intermittent fever, 1 2
Purging, its ufe in continued fevers, 144
intermittent fevers, 234
Pus, how produced, 250
PuTRESCENCYof the fluids in fever, the fymp-
toms of, 1 05
the tendency to in fever, how to
be corrected,
222 — 226
Pylorus, scirrhous. See Dyfpepjia.
Pyrexia,
6
character of the clafs,
7
orders of the clafs,
7
Pyrosis,
1427
fymptoms of,
M3*
proximate caufe of,
x433
remote caufes of,
1432
Hh3
Py-
478 INDEX.
Pyrosis, cure of, 1434
Suecica of S au vages, 1428
Quinsy. See Cynancke.
R.
Rachitis, 1719
its origin, 1720
remote caufes of, 1721 — 23
phenomena of, '7^4
proximate caufe of, 1725 — 28
cure of, 1729 — 36
Reaction of the fyftem, 59
violent in fever, fymptoms of, 1 o3
violence of, how moderated, 127
Reprigerants, the ufe of them in fever, 134
Remedies, table of thofe employed in continued
fevers, 227
Remission of fever, 26*
Resolution of inflammation, how produced, 249
Respiration, the changes of, during the pa-
roxyfm of an intermittent, 13
Revolution, diurnal, in the human body, 55*
Rheumatism, acute or chronic, 433
Acute, the remote caufes of, 436
the proximate caufe of. 453 — 460
Rheu-
N D E X.
479
Rheumatism, acuts, the fymptoms of, 4^9 — 447
cure of, 461 — 470
Chronic^ fymptoms of, 450
how diftinguifhed from the acute, 451
proximate caufe of, 472
cure of, 473—476
how diftinguifhed from gout, 526
Rickets. See Rachitis.
Rose. See Erythema.
Rubefacients, the effects of them.
5.
Scarlet fever, 651
the fymptoms of, 656
different from cynanche maligna, 651 — 655
the cure of, 657 — 664
^CROPHULA, 1738
the phenomena of, 1738 — 1749
the proximate caufe of, 1750
not contagious, 1751
not arifing from the lues venerea, 1752
the cure of, 1753 — 59
Me/enterica, 1606
Scurvy, 1789
remote caufes of, 1792 — 1802
cure of, 1804—09
proximate caufe of, 1 8 1 1 — 14
H h d Sina-
48q index.
Sinapisms, the effects of them, 197
Skin, affections of. See Impetigincs.
Small-pox, general character of, 587
fymptoms of the diftinct kind, 589
of the confluent kind, 590 — 593
general differences between diftinct
and confluent, 594
caufes of thefe differences, 595 — 600
prognofis in, 493
cure of, 601 — 630
inoculation of, 602
the feveral practices of
which it confifts, 603
the importance of the fe-
veral practices belong-
ing to, 604 — 615
management of fmall-pox received
by infection, 616 — 630
Soda, 1427
Spasm, internal, means of removing in fevers, 152 — 187
the proximate caufe oi inflamma-
tion, 243 — 248
Spasmodic affections without fever, 1251
of the animal functions, ^54
of the vital functions, I355
of the natural functions, 1427
Sphacelus, 25c
Sple-
INDEX. 481
Splenitis, 425
Stimulants, when to be employed in fevers, 217
their ufe in intermittent fevers, 230
Stomach, its content with the vcflels on the fur-
face of the body, 44
Sudorific'., arguments for their ufe in fe-
vers, 163 — 167
againft their ufe in fevers, 164
Suppuration of inflamed parts, the caufes of, 251
the marks of a tendency to, 25 r
formed, the marks of, 25 1
Surface of the body, its confent with the fto-
mach, 4^
Swellings, general. See I ntumefc entice.
adipofe, 1621
flatulent, 1626
watery. See Dropjies.
Sweating, when hurtful in continued fevers, 16$
rules for the conduct of in continued
fevers, 168
ufe of in intermittent fevers, 230
Syncope, 1171
phenomena of, 1171
remote caufes of, I174 — 1178
predifpofition to, 1 1 84
cure of, 1 1 89
Syn-
482 INDEX.
Syncope, diftinguimed from apoplexy, ICp4
Synocha. See Fever.
Synochus. See Fever.
MPHYLIS,
1760
originally from America,
1761
how propagated,
1762
and gonorrhoea, how diftinguimed, 1 764
cure of,
1783—88
T.
Tabes ahydrope,
1609
a fanguifluxu,
1608
dorfalis,
1610
glandularis,
1606
mefenterica^
1606
nutricum,
1608
rachialgia,
1606
fcrophulofa,
1606
Tartar emetic, its ufe in fevers,
185
Tetanus,
1257
remote caufes of,
1268
cure of,
1270
piflileum Barbadenfe, or Barbadoes
tar, in, 1280
LATERALIS,
1268
Tonic medicines employed in continued fevers, 21 1
intermittent
fevers, 231
Toothach, how far different from rheuma-
tifm,
477—480
fymptoms of,
478
3
Tooth-
INDEX. 483
Toothach, predifpofition to, 48 r
remote caufes of, 481 — 482
proximate caufe of, 483
cure of, 485 — 491
Trismus. See Tetanus.
NASCENTIUM, I28l
Tussis. See Catarrh.
Tympanites, the character of, 1627
the different fpecies of, 1628 — 30
inteftinalis, 1628
enterophyfodes, 1628
abdominalis, 1628
afciticus, 1628
phenomena of, 1632
proximate caufe of, 1635 — 36
cure of, 1637 — 44
Typhus. See Fever.
the fpecies of, 70
Vapours, or low fpirits. See Hypochondria/is.
Venereal disease. See Siphylis.
Venery, excefs in, a remote caufe of fever, 97
Vesani^,
in general, 1528
Vis medicatrix naturje, 38
StVitus'sDance. See Chorea.
Vomiting of blood. See Hamatemejis.
effects of in continued fevers, 172, 173
Vomit-
484 INDEX.
Vomiting, the ufe of in intermitting fevers, 230-34
Vomiting of blood. See Hamatemejis.
Urine, bloody. See Hamaturia.
Urticaria, the hiftory and treatment of, 730
W.
Water-brash. See Pyr&fts.
Whites. See Leucorrhcea.
Wa r m b a t h 1 n g, the effe&s of in fever, 1 98
the adminiftration of in fevers, 199
the marks of the good effe&s, 2CO
\Vine, the moil proper ftimulant in fevers, 218
its convenient ufe in fevers, 219
when hurtful or ufeful in fevers, 220
THE END.
PRINTED B T
MACFAR$JJHAR and ELLIOT.
foots printed for and [eld by C. E i. lio t, Edinburgh; and
C. ElUOT, T.KAT, .m./Co. at Dr Cullcn's Head, Nu 332,
Strand, London.
i. rPHE Edinburgh New Difpenfator^ ngall that was ufefu!
■*■ and neceflaryin Dr Lewis's celebrated o^ij^olatory ; towbicbii
added, the numerous difcoteriei and improvement! (ince his time ;
and alfo new tables of elective attractions Angle and double, of an-
timony, mercury, &c. ; and fix copperplates of chemical and phar-
maceutical inftrumcnti (including the furnaces, <^c. ufed and re-
commended by Dr Black of Edinburgh.) — By Charles Wcbfter, M.D.
and Ralph Irving, M. D. Jn one very large vol. Svo (784 pages),
price only 7s. 6J. neatlv bound.
2. Svnopfis Nofologia* Methodical, exhibens clariff. virorum Sauva-
geiii, Linnsi, Vogelii, et S.igari, fyftemata nolblogica. Fdidit,
luumque proprium fy (tenia nofologicum adjecit, Gulielmus Cullen,
2, vols 8vo. 12s. boards.
3. Inttitutions of Medicine, by William Cullen, M. D. &c. Sec. in
one vol. 8vo, 4s. boards.
4. Dr Cullen on the Recovery of PefTons drowned and feemingly
dead. 8vo, is. fewed,
f. Ftrft Lines of the Practice of Phyfic, by William Cullen, M.D.
ProfefTor of the Practice of Phyfic in the Univerfity of Edinburgh,
&c. &c. A New Edition, corrected and enlarged, in four vols 8vo,
Price il. 4s. in boards.
6. The Structure and Phyfiologv of Fifties explained, and compared
with thofe of Man, illuftrated with 50 large copperplate?, in one
very large volume folio. By Alexander Monro, M.D. Fellow of
the Royal College of Phylkians, and Profeffor of Phyfic, Anato-
my, and Surgery, in the Univerfity of Edinburgh. Price al. 2s.
boards
7. Cbfervations on the Structure and Functions of the Nervous Sy-
ftem, illuftrated with Tables. By Alex. Monro, M. D. Preftdent
of the Royal College of Phylkians, and Profeffor of Phyfic, Ana-
tomv, and Surgerv, in the Univerfity of Edinburgh, si. 2s. boards.
8. The Works of Alexander Monro, M. D. F. R. S. Publifhed by
his Son Alexander Monro. M. D. &c. To which is prefixed, the
Life of the Author. In one very large volume in quarto, elegantly
printed upon a royal paper, and ornamented with a capital Engra-
ving of the Author by Mr Bafire, from a punting by Allan Ram-
fay, Efq; befides feveral copperplates illuftrative of the fubjects.
Price il. 5s. in boards.
The Doctor's Works contain, amongft others, all the beft, and
by far the greateft number, of articles in the Edinburgh Medical
Effays, and feveral in the Phyiical and Literary.
9. A Treatife on Comparative Anatomy, by Alex. Monro, M. D,
F.R.S. &c. &c. Publifhed by his Son Alexander Monro junior,
M. D. A new edition, with confiderable improvements and addi-
tions by othsr bands, izmo. Price 2s. in boards.
10. Monro's Account of the inoculation of the Small-pox in Scotland,
8vo, is.fewed.
11. A Syftem of Anatomy and Phyfiologv, from Monro, Winflow,
Innes, Hewfon, Haller, &c. and the lateft Authors. Arranged, as
nearly as the nature of the work would admit., in the order of the
Lectures
Books publijbed by C. Elliot, Edinburgh and London;
Lectures delivered by the Profeflbr of Anatomy in the Univerfity of
Edinburgh. The Second Edition; to which is added, The Compara-
tive Anatomy. By a Gentleman of that Univerfity. In three vols
8vo, illuftrated with 16 Copperplates. Price 18s. boards.
li. A Syftem of Surgery ; by Benjamin Bell, Member of the Royal
Colleges of Surgeons of Ireland and Edinburgh, one of the Sur-
geons to the Royal Infirmary, and Fellow of the Royal Society of
Edinburgh. Illuftrated with Copperplates. Vol. I. II. II [. IV. and V.
8vo, 6s. each, boards. This work, when completed, with a for-
mer volume on Ulcers, &c. (4th edition) by the fame Author, will
comprehend a full Syftem of Modern Surgery. Vol. VI. will be
published as foon as poflible ; which will complete the work.
Any volume fold feparately.
13. A Treatife on the Theory and Management of Ulcers, with a
DifTertation on White Swellings of the joints. To which is pre-
fixed, An Eflay on the Chirurgical Treatment of Inflammation
and its Confequences. By the fame Author. A new edition, be-
ing the fourth, confiderably improved and enlarged, 6s. in boards.
14. Innes's Eight Anatomical Tables of the Human Body, containing
the principal parts of the Skeleton and Mufcles represented in the
large Tables of Albinus ; to which are added, Concife Explana-
tions. A new edition, with an Account of the Author. Neatly
half-bound, quarto, price 6s. 6d.
15. Innes'6 ftiort defcription of the Human Mufcles, chiefly as they
appear on di flection ; together with their feveral ufes, and the fy-
nonima of the beft authors. A new edition, greatly improved by
Alex. Monro, M. D. as. 6d. in boards.
16. Sharped Operations in Surgery, plates, 8vo, 4s. 6d.
17. Outlines of the Theorv and Practice of Midwifery, by Alexander
Hamilton, M.D. F. R. S. Edin. Profeflbr of Midwifery in the Uni-
verfity, and Member of the Koyal College of Surgeons* Edinburgh,
a new edition, price 6s. bound ; or, with Dr Smellie's 40 Tables
and Explanations, us. boards, and 12s. bound.
18. Dr Alexander Hamilton's Treatife on Midwifery and Female
Complaints, with the Treatment of Lying-in-"VVomen, and the
Management of New-born Children, for the ufe of Female and
other Practitioners and private Families. It may be had with Dr
Smeliie's 40 Plates and Explanations at 10s. in boards, or without
the fame at 4s. only.
19. A Treatife on the Theory and Practice of Midwifery; By W.
Smellie, M D. To which is now added, his Set of Anatomical
Tables, exhibiting the various Cafes that occur in Practice ; accu-
rately reduced and engraved by A. Bell, on 41 Copperplates, (in-
cluding two additional Plates of Inftruments, by the late Dr Tho-
mas Young and Dr Evans) with Explanations. A u<jw edition,
on fine paper and large print, in 3 vols umo. Price 10s. 6d. in
boards, or ias. bound.
ao. Dr Smellie's Set of Anatomical Tables, and an Abridgment of
the Practice of Midwifery, with a view to illuftrate his Treatife on
that Subject and Collection of Cafes. A new edition, carefully
corrected and revifed, with Notes and Illuftrations adapted to the
?refent improved method of Practice. By Alexander Hamilton,
M.D.
Sacks publijhed by C.Elliot, Edinburgh and Loiai
M. D. F. R. S. Edin. ami Profeflbr of Midwifery in the Univcr-
. fit y of Edinburgh. 8vo, 6s. in boards.
-i. The Third Edition, corrected, of Medical Cafes, felected from
the Records of the Public Difpenfary at Edinburgh ; with Remarks
and Obferatiotll. By Andrew Duncan, M. D. F. R. S. and A. Si
Phyfician to the Prince of Wales for Scotland, &c. Price 6s.
bound.
Avery fine Print of Dr Duncan, painted by Weir, and engraved
by Trotter. Price zs. 6d.
a». Dr Duncan's Heads of Lectures on the Theory and Practice of
Medicine, with the Pathology, izmo, 3s. 6d. boards.
aj. Dr Duncan's Medical Commentaries, for 1783 — 4, 8vo, 6s.
boards.
14. The fame for 17S5, 6s. boards.
25. Medical Commentaries for the yeir 1786, collected and publifhed
by A. Duncan, M. D. F.R.andA. S. Edin. VolumeI. DecadeII.
price 6s. in boards.
26. The fame Book., Decade I. from 1773 to 1785 inclulive, 10 vol.
8vo, price 3I. 10?. Any vomme feparate.
S7. Observations on the Animal Oeconomy, and on the Cauft-s and
Cure of Difeafes. By John Gardiner, M. D. Prefident of the Royal
College of Phyficians, and fellow of the Royal Society of Edin-
burgh. Price 6s. bound.
a8. Baron Hallcr's Firlt Lines of Phyfiology, tranlhted from the cor-
rect Latin copy printed under the infpection of W.lliam Collen,
M. D. To which is added, a tranfla'ion of the elaborate Index
compofed for that edition. The prefect edition has been compared
with the laft pubdiihed at Gottingen by Profeflbr Wriftberg, and
includes a tranflation of the whole of his Notes added to that edi-
tion, a vols 8vo.
39. Thefaurus Medicus, fiveDifputationum in Academia Edinenfi ad
Rem Medicam pertinentium, a Collegio inftituto ad hoc ufque
tempus, delectus, 4 vols Svo. The whole is executed by the lap-
probation of the prefent profeflors of the different branches of the
healing art. Vol. IV. brings this Collection down to the year 1785,
and the work is enriched with Dr A. Monro, junior's celebrated theiis
De tsjTibus it defemine in varus animatibus% who obligingly f or min-
ed the publifher with the accurate original engravings ioi liluitrating
this fuhjed, il. 6.-. in boards.
30. Thefaurus Medicos F.dinburgenfis Novus, ab 1759 ad 1785, i vols
Svo, 14s. in boards. This felecrion ^by the Royal Medical Society)
contains ;,8 of the lateft and belt Theies, and a lift of all the Gra-
duations for the period.
31. Swieten's { Baron Van) Commentaries upon Boerhnave's Aplio-
rifms concerning the Knowledge and Cure of Difeafes; a correct
edition, dedicated to Dr Cullen, iS vols Iimo, royal paper, neatly
bound in calf, 3!. 3s.
3a. Firft Lines of the Theory and Practice, of the Venereal Difeafe,
by William Nifbet, M. D. Fellow of the Royal College of Sur-
geons, Edinburgh, &c. Svo. Price 5s. in boards.
33. Practical Obfervations on the more obftinate and inveterate Vene-
real Complaints, by J. Schwediauer, M. D. a new edition, impro-
ved, 8vo. Price 4s. fewed.
34. Experiments on the Red and Quid Peruvian Bark; with Obfer-
vations on its Hiftory, mode of Operation, and Ufes ; and on fome
other
V*
Books pullifh:J by C. Elliot, Edinburgh and London.
other Subjctfrs connected with the Phenomena and Doctrines of Ve-
getable Aftringents. Being a Differtation which gained the firft
prize given by the Harveian Society of Edinburgh for the year 1784.
By Ralph Irving, M. D. Oire vol. Svo. Price ;s boards.
y. An Inquiry into the Nature and Caufes of Fever ; with a Review
of the feveral Opinions concerning its proximate Caufe, as advanced
by different Authors, and particularly as delivered from the Practi-
cal Chair in the Univerfity of Edinburgh. Including fome Oblerva-
tions on the Exigence of Putrefaction in the living Body, and the
proper method of Cure to be purfued in Fever. By Caleb Dick-
infon, M. D. Price 3s.
56. Encyc opaedia Britannica ; or, A Dictionary of Arts and Scien-
ces, with about 300 Copperplates. This valuable work includes
the fubftance of all the different Profeffors Lectures, in 10 vols
large 4to. Price 12I. in boards
37. Gaubius's Inftitutions of Medicinal Pathology, tranflated by
Charles Erfkine furgeon. Price 2s. 6d. in boards.
38. Compendium Anatomicum, totam Rem Anatomicam breviffime
compleclens. Auctore B. D. L. Heiftero, M. D. Editio Nova,
in izmo, 3s. in boards.
^9. Differtatio de Natura et Ufu Laclis in diverfus Animalibus, auc-
tore Thoma Young, M. D. in Acade'mia Edinenli Artis Obftetricas
Prof, 8vo. is. fewed.
40. Celfus de Medicina, curavit A. Morris, cum Indice, 8vo, 5s.
bound.
4i« A fine Mezzotinto Engraving of Dr William Cullen, by Val.
Green, from a painting of W. Cochrane, Efq; done at the expence
of the Roval Medical Society, price 36.
4:. Dr Balfour on the Influence of the Moon in Fevers. Published
by the defire and recommendation of Dr Cullen, Svo, is. 6d.
fewed.
43. Albinus's Tables <of the Skeleton and Mufcles of the Unman
Body, with Explanations; engraved by Andrew Bell. Neatly
half-bound, il. 13s. or in boards, il. ns. 6d. in folio.
44. Lind on the Putrid and Remitting Marfn- fever which raged at
Bengal in the year 1762, being a translation of his Thcfis, Svo, is.
4j. Inftitutiones Medicas, in ufus aunuSe exercitationis domefticos,
Higeftx ab H. Boerhaave, Svo, jr. bound.
46. Harveii Exercitation.es Anatomicce, de Motu Cordis et Sanguinis
Circulations, fine foolfcap 8vo, 3s 6d. and tine thick port 8vo, $s.
both neatly bound.
47 A Treatife upon the Extraction of the Cryftallne Lens. By Geo.
Borthwick, Surgeon to the 14th Regiment of Dragoons, Svo, 6d.
fewed .
48. Oratio coram Societate Phyfica, die quo piimum ad iEdes novas
dtdicandas convenit, quam habui' Thomas Addis Emmet, M D.
ejus, nee non Societatum. Reg. Med. Nat. Hift. et Speculative,
praefes animus-. Price 6d.
49. Mead's whole Medical Works, complete in one volume 8vo
plates, 6s- bound.
/
<
1 ]
i
! ■
;
1
; ■
H
n i
1
H
1 :
H
■■■■
I
Live Music
Archive
Librivox
Free Audio
Metropolitan Museum
Cleveland
Museum of Art
Internet
Arcade
Console Living Room
Open Library
American
Libraries
TV News
Understanding
9/11